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  • 51.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Practitioner, Researcher and Gender Conflict in a Qualitative Study.1999In: Qualitative Health Research, Vol. 9, no 4, p. 455-467Article in journal (Refereed)
  • 52.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Candib, L
    Chapter 4. Understanding the whole person.2002In: Chronic myofascial pain - a patient-centered approach., Oxford: Radcliffe Medical Press Ltd , 2002Chapter in book (Other academic)
  • 53.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Lindgren, Gerd
    "I was always on guard"--an exploration of woman abuse in a group of women with musculoskeletal pain.1999In: Fam Pract, ISSN 0263-2136, Vol. 16, no 3, p. 238-44Article in journal (Refereed)
  • 54.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindgren, Gerd
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Scientific rigor in qualitative research: examples from a study of women´s health1994In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 11, p. 176-181Article in journal (Refereed)
    Abstract [en]

    The increase in qualitative research in family medicine raises a demand for critical discussions about design, methods and conclusions. This article shows how scientific claims for truthful findings and neutrality can be assessed. Established concepts such as validity, reliability, objectivity and generalization cannot be used in qualitative research. Alternative criteria for scientific rigour, initially introduced by Lincoln and Guba, are presented: credibility, dependability, confirmability and transferability. These criteria have been applied to a research project, a qualitative study with in-depth interviews with female patients suffering from chronic pain in the locomotor system. The interview data were analysed on the basis of grounded theory. The proposed indicators for scientific rigour were shown to be useful when applied to the research project. Several examples are given. Difficulties in the use of the alternative criteria are also discussed.

  • 55.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindgren, Gerd
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    The impact of marital relationship on the rehabilitation process in a group of women with long-term musculoskeletal disorders.1997In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 25, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    This qualitative study investigated problems in the rehabilitation of women with long-term, musculoskeletal pain disorders. Data were collected by repeated semi-structured interviews and doctor-patient encounters during two years, and analysed in a gender perspective. The “marriage contract”, i.e. the pattern of division of duties and power structure within the marital relationship, was of obvious importance to the implementation of rehabilitation measures. We explored situations where the rehabilitation measures disagreed with the terms and patterns in the “marriage contract”. The participants' ways of coping with the contract in these delicate situations could be described as three type strategies; accepting the terms, negotiating for new terms, and breaking the contract. The crucial impact of the “marriage contract” and the type strategies on the rehabilitation process are exemplified.

  • 56.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Malterud, Kirsti
    Chapter 5. The patient-clinician relationship.2002In: Chronic myofascial pain - a patient-centered approach., Oxford: Radcliffe Medical Press Ltd. , 2002Chapter in book (Other academic)
  • 57.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Mattsson, B
    [The picture of the psychiatrist should be more nuanced. General practitioners react to articles on depression in primary health care]1998In: Lakartidningen, ISSN 0023-7205, Vol. 95, no 12, p. 1291-2, 1295; discussion 1295Article in journal (Other academic)
  • 58.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine.
    Larsson, Marie-Louise
    Still far to go: gender perspective in written cases used at a Swedish medical school2009In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 31, no 4, p. e131-e138, article id PII 910828740Article in journal (Refereed)
    Abstract [en]

    Objective: Given decisions to implement a gender perspective in medical education, this study investigated gender perspective in written cases used at a Swedish medical school.

    Method: All course organizers on terms 5–11 were asked to submit the case descriptions used in 2005. The 257 cases collected were subjected to content analysis focussing on sex of author and patient; whether there were any guidelines for tutors; and whether the case touched on biological sex differences, psychosocial and gender aspects.

    Results: The majority of cases were written by male teachers. The proportions of male and female patients were equal. There were instructions for tutors in 20% of the cases. Sex differences were mentioned in 7% of cases. Psychosocial data were meager. Ten cases (4%) contained gender aspects and four of them presented gender as a main issue.

    Conclusions: The lack of instructions for tutors and overall scant interest in psychosocial issues were important obstacles for gender implementation. Actually, ignoring psychosocial conditions means that a gender perspective is also neglected. The results illuminate the importance of monitoring and follow-ups for a successful implementation of gender. Our method of scrutinizing written cases might be useful also for other medical schools.

  • 59.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Naredi, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Genusperspektiv i kirurgi2010In: Kirurgi / [ed] Bengt Jeppsson, Peter Naredi, Jörgen Nordenström, Bo Risberg, Studentlitteratur , 2010, p. 195-210Chapter in book (Other academic)
  • 60.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Phillips, Susan P
    Queens University, Department of Family Medicine and Public Health Sciencies, Kingstone, Ontario, Canada.
    Sex or gender? Conceptual confusion is common.2015In: Hypertension News. Web Journal for International Society of Hypertension., no 12, p. 13-14Article in journal (Other academic)
    Abstract [en]

    When researchers study sex or gender differences in health outcomes they often find significant disparities. But what do sex or gender actually mean and measure? The simplest answer is to consider that all subjects are either women or men and to group them accordingly. Historically differences between the women and men were thought to arise from biology, reproductive organs, hormones or biological processes. This is what the term 'sex' generally means. The division between sex and gender in social science research developed in the 1960s. The split highlighted the need to move beyond a narrow focus on biology and recognize that socioeconomic conditions and cultural norms also shape and constrain education, career choices, salaries, and health. The term, gender refers to social aspects of being a man and woman, features that are formed in relation to upbringing, conditions in daily life, norms and culture.

  • 61.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Risberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Male and female physicians show different patterns of gender bias: a paper-case study of management of irritable bowel syndrome.2004In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 2, p. 144-152Article in journal (Refereed)
    Abstract [en]

    AIMS: Research has raised concerns about gender bias in medicine, i.e. that men and women might be treated differently due to gender-stereotyped attitudes among physicians. The authors investigated gender differences in medical management of a common health problem, irritable bowel syndrome (IBS). METHOD: In a national examination for Swedish house officers, the examinees were allocated to suggest management of IBS in either a male or female paper-patient. The case description was identical in both genders with the exception of prior prostate and gynaecological symptoms. The open answers were coded for analysis. A total of 289 physicians (45% women) participated. Chi-squared tests were used to measure differences in proportions. RESULTS: In variables focusing on medication, weight, gynaecological problems, tobacco, alcohol, thyroid function, proposed diagnoses, X-ray of the colon, and advice about lifestyle, significant or close to significant gender differences were seen. Both male and female physicians made gender differences but they did not show the same pattern of differences. CONCLUSIONS: The results suggest that gender bias is involved in medical management of IBS but men and women physicians may show disparate patterns of gender bias. There is a need for larger studies on gender differences in medical management with designs making it possible to consider the gender of both the patient and the physician. Furthermore, the results call attention to 'knowledge-mediated gender bias', a phenomenon implying that once knowledge about gender differences in a condition has been established, this might in fact cause gender-biased assessments of individual patients in clinical practice.

  • 62.
    Hamberg, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Risberg, Gunilla
    Johansson, Eva
    Westman, Göran
    Gender bias in physicians' management of neck pain: a study of the answers in a Swedish national examination.2002In: J Womens Health Gend Based Med, ISSN 1524-6094, Vol. 11, no 7, p. 653-66Article in journal (Refereed)
  • 63.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Perceptions of living with a device-based treatment: an account of patients treated with deep brain stimulation for Parkinson’s disease2014In: Neuromodulation (Malden, Mass.), ISSN 1094-7159, E-ISSN 1525-1403, Vol. 17, no 3, p. 272-278Article in journal (Refereed)
    Abstract [en]

    Objectives Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Little is known about patients' own perceptions of living with the implanted hardware. We aimed to explore patients' own perceptions of living with an implanted device. Materials and Methods Semistructured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions focused on patients' experiences of living with and managing the DBS device. The interviews were transcribed verbatim and analyzed according to the difference and similarity technique in grounded theory. Results From the patients' narratives concerning living with and managing the DBS device, the following four categories emerged: 1) The device—not a big issue: although the hardware was felt inside the body and also visible from outside, the device as such was not a big issue. 2) Necessary carefulness: Patients expressed the need to be careful when performing certain daily activities in order not to dislocate or harm the device. 3) Continuous need for professional support: Most patients relied solely on professionals for fine-tuning the stimulation rather than using their handheld controller, even if this entailed numerous visits to a remote hospital. 4) Balancing symptom relief and side-effects: Patients expressed difficulties in finding the optimal match between decrease of symptoms and stimulation-induced side-effects. Conclusions The in-depth interviews of patients on chronic DBS about their perceptions of living with an implanted device provided useful insights that would be difficult to capture by quantitative evaluations.

  • 64.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. UCL Institute of Neurology, Queen Square, London, UK.
    Limousin, P.
    Zrinzo, L.
    Tripoliti, E.
    Aviles-Olmos, I.
    Jahanshahi, M.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Foltynie, T.
    Gender differences in quality of life following subthalamic stimulation for Parkinson's disease2013In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 128, no 4, p. 281-285Article in journal (Refereed)
    Abstract [en]

    Objectives - Surveys of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) have shown that this procedure is roughly twice more common in men than in women. Here, we investigate possible differences between women and men undergoing STN DBS, with respect to health-related quality of life.

    Materials and methods - Forty-nine consecutive patients (18 women) received STN DBS. The impact of PD and its surgical treatment was compared between women and men, before and at mean of 19 +/- 11months after surgery, using the Unified Parkinson Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire-39 (PDQ-39).

    Results - Duration of disease at surgery and off-medication scores of the motor part of the UPDRS were similar in women and men. At baseline, women had lower doses of dopaminergic medication than men, experienced more disability due to dyskinesias, had more sensory symptoms and perceived more difficulties in mobility. Following DBS, both men and women showed equal and significant (P<0.001) improvement in off-medication scores on the UPDRS III. On the PDQ-39, women expressed improvement in ADL to a greater extent than men. Moreover, women but not men showed a positive effect on mobility, stigma and cognition as well as on the summary score of PDQ-39.

    Conclusions - Although STN DBS results in equal degree of motor improvement between women and men, health-related quality of life seems to improve to a greater extent in women.

  • 65.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Limousin, Patricia
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "DBS means everything - for some time": Patients' Perspectives on Daily Life with Deep Brain Stimulation for Parkinson's Disease2016In: Journal of Parkinson's Disease, ISSN 1877-7171, E-ISSN 1877-718X, Vol. 6, no 2, p. 335-347Article in journal (Refereed)
    Abstract [en]

    Background: Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. However, patients' own perceptions of the impact of DBS on their daily living is not fully explored. 

    Objective: We aimed to collect and analyse patients' narratives about their everyday experiences of being on chronic DBS. 

    Methods: Semi-structured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions were related to patients' ordinary daily life and eventual changes, both negative and positive, brought about by DBS. The interviews were transcribed verbatim and analysed according to the difference and similarity technique in grounded theory. 

    Results: From the patients' narratives the core category `DBS means everything - for some time' was established, and supported by the following categories: 1) Relief from invasive tremor. 2) A rescue from cramps and pain. 3) Easier movement swings and more predictable living space. 4) Hard, but compared to previous suffering, bearable adverse events. 5) Parkinson's disease is progressing despite DBS. 

    Conclusions: The analysis of the participants' narratives shed light on patients' unique perceptions and perspectives of the impact of DBS on their everyday lives. Patients with advanced PD highly appreciated the positive impact of DBS on their daily life even if this impact is limited in time. For the majority, the relief from the severe parkinsonian symptoms, especially tremor and painful cramps, outweighed the side effects of DBS. The study provided information not readily captured by pre-formulated questionnaires and scales.

  • 66.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Nakajama, Takeshi
    UCL Institute of Neurology, Queen Square, London, UK; Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan.
    Limousin, Patricia
    UCL Institute of Neurology, Queen Square, London, UK.
    Foltynie, Tom
    UCL Institute of Neurology, Queen Square, London, UK.
    Zrinzo, Ludvic
    UCL Institute of Neurology, Queen Square, London, UK.
    Jahanshahi, Marjan
    UCL Institute of Neurology, Queen Square, London, UK.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender distribution of patients with Parkinson's disease treated with subthalamic deep brain stimulation: a review of the 2000-2009 literature2011In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 17, no 3, p. 146-149Article, review/survey (Refereed)
    Abstract [en]

    Purpose: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been the mainstream surgical procedure for advanced Parkinson’s disease (PD) during the last decade. Reports from a few individual centres have hinted that women who receive STN DBS are under-represented. We aimed to evaluate the gender distribution of patients with PD who had received STN DBS during the last ten years, and to discuss the findings in relation to studies on gender prevalence of PD.

    Methods: A search of the PubMed database of clinical papers in English language related to STN DBS between 2000 and 2009 was conducted. Care was taken to minimize redundancies in reporting of published patients. The proportion of men and women were expressed in total and according to pre-defined geographic regions.

    Results: One hundred and thirty five papers were eligible for review. The gender of the patients was specified in 119 papers on a total of 3880 patients, of which 63% were men. According to geographic origin of publications, the percentage of men with STN DBS was 68% in North America, 62% in Europe, 69% in Australia and 50% in Asia.

    Conclusions: The proportion of male patients who undergo STN DBS seems to exceed the reported male/female ratio of patients with PD.

  • 67.
    Hariz, Gun-Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Rehncrona, Stig
    Blomstedt, Patric
    Limousin, Patricia
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hariz, Marwan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience. UCL Institute of Neurology, Queen Square, London, UK.
    Women pioneers in basal ganglia surgery2014In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 20, no 2, p. 137-141Article, review/survey (Refereed)
    Abstract [en]

    Background: Stereotactic functional neurosurgery on basal ganglia has a long history and the pioneers are mostly men. We aimed at finding out if there were women who have contributed pioneering work in this field. Methods: The literature was searched to identify women who have been first to publish innovative papers related to human basal ganglia surgery. Results: Six women fulfilling our criteria were found: Marion Smith, a British neuropathologist, made unique observations on stereotactic lesions of basal ganglia and thalamus on autopsied brains, and the lesions' relation to the reported clinical outcome. Natalia Bechtereva, a Russian neurophysiologist, pioneered the technique of therapeutic chronic deep brain stimulation to treat various brain disorders, including Parkinson's disease (PD). Denise Albe-Fessard, a French neurophysiologist, pioneered the technique of microelectrode recording (MER) in stereotactic functional neurosurgery. Gunvor Kullberg, a Swedish neurosurgeon, contributed in early CT imaging as well as early functional imaging of stereotactic lesions in PD and psychiatric patients. Hilda Molina, a Cuban neurosurgeon, established the Centro Internacional de Restauracion Neurologica (CIREN) and pioneered there MER-guided transplant surgery in PD patients. Veerle Vandewalle, a Belgian neurosurgeon, pioneered in 1999 deep brain stimulation (DBS) for Tourette Syndrome. Conclusion: Although men constitute the great majority of neurosurgeons, neurologists and other neuro-specialists who have made groundbreaking contributions in basal ganglia surgery, there are women who have made equally important and unique contributions to the field. The principal two techniques used today in functional stereotactic neurosurgery, MER and DBS, have once upon a time been pioneered by women. (C) 2013 Elsevier Ltd. All rights reserved.

  • 68. Johansson, Eva E.
    et al.
    Hamberg, Katarina
    Lindgren, Gerd
    Westman, Göran
    "I've been crying my way": qualitative analysis of a group of female patients' consultation experiences1996In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 13, no 6, p. 498-503Article in journal (Refereed)
    Abstract [en]

    Background and objectives What do women patients, sick-listed for biomedically undefined musculoskeletal disorders, expect and experience when they consult a doctor? With the purpose to learn more about this, a qualitative interview study was conducted.

    Methods Twenty women participated. They were patients at an urban health care centre in northern Sweden. Data were gained through repeated, semi-structured interviews, and analysed according to grounded theory.

    Results The participants described an atmosphere of distrust in the consultation. They had felt ignored, disregarded and rejected by doctors, and had worked out strategies to keep up medical attention in their search for a creditable diagnosis. They were somatizing, claiming under cover, and pleading, to catch the doctor's interest. In addition, they upheld their self-respect by mystifying and martyrizing themselves and their symptoms, and by condemning physicians as ignorant.

    Discussion The patient's consultation experiences are discussed from different aspects; the biomedical framework, the power asymmetry, and the gendered positions of patient and doctor. The findings indicate the importance of making doctors aware of the context behind frustrations in doctor-patient interaction.

  • 69.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    From calling to a scheduled vocation: Swedish male and female students' reflections on being a doctor2007In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 29, no 1, p. e1-e8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: All over the world an increasing number of women are entering medical schools. Soon women will constitute half of the physician workforce in Scandinavia. However, specialty segregation persists. Reports have shown different motives among male and female doctors to be, but the impact of gender, i.e. how ongoing social constructions of femininity and masculinity influence the development of professionalism, is not fully described.

    AIM: The purpose of this study was to explore views and visions among second-year students at a Swedish Medical School, and to identify challenges for education and workforce planning.

    METHODS: After receiving research ethics board approval, all students participating in the course 'Professional development', including a task to write a free-text essay on the theme 'to be a doctor', were invited to share their essays for analysis. Of 138 (40% men) students in 2002, 104 (39% men) accepted. The texts were analysed according to grounded theory.

    RESULTS: Students held 'doctorship' to be an outstanding profession of commitment, authority and duty. Fears were exposed, especially among women, regarding how to fit demands of self-sacrifices and balancing a private life. Belonging to a new generation, they conceived gender equity as self-evident. Actual working conditions were met with disapproval, as did an all-embracing calling. A scheduled vocation was hoped for. They relied on the mass of women to implement change. Women's 'other' values, alluding to family orientation, were expected to alter working conditions and also give men more leisure time. Despite equity conviction, segregating gender patterns in students' representations, interactions with tutors and future prospects were disclosed.

    CONCLUSIONS: Students' arguments raise challenges for medical educators and planners regarding professional values, medical socialization and specialty recruitment. The new generation requires a renewed Hippocratic Oath, gender-aware role models and practice sites. Swedish students' arguments are compared with current international literature.

  • 70.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Vad händer i mötet? - En analys av kvinnliga värkpatienters konsultationserfarenheter.1998In: Socialmedicinsk Tidskrift, Vol. 1-2, p. 24-27Article, review/survey (Other (popular science, discussion, etc.))
  • 71.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Women in pain: the meaning of symptoms and illness.2002In: Chronic myofascian pain.: A patient centered approach., Radcliffe Medical Press, Oxon , 2002, p. 58-70Chapter in book (Other (popular science, discussion, etc.))
  • 72.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindgren, Gerd
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "How could I even think of a job?": ambiguities in working life in a group of female patients with undefined musculoskeletal pain1997In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 15, no 4, p. 169-174Article in journal (Refereed)
    Abstract [en]

    Objective - To explore the meaning of working life for a group of women sick-listed because of undefined, musculoskeletal pain disorders.

    Design - Repeated thematic interviews, analysed qualitatively according to grounded theory.

    Setting and participants - Twenty female patients, impaired by biomedically undefined pain and musculoskeletal disorders, were successively recruited at an urban primary health care centre in northern Sweden.

    Main findings - There were discrepancies between work aspirations and work experiences concerning economic maintenance, social interaction, and personal recognition. The women had low-income jobs in fields threatened by redundancy, such as cleaning, care, and service. Family considerations had a strong impact on organization and priorities in paid work. In a situation of pain and sick leave, family orientation strengthened and work aspirations declined. Social and personal recognition was sought in the unpaid ’duties at home, and economic refuge in ‘the state as supporter’.

    Implications - To understand women with undefined musculoskeletal pain as patients, we must also understand their aspirations and experiences as workers, mothers, and spouses. ‘Family considerations’, ’diminishing paid work’, and ’the state as supporter’ are important concepts for understanding the women’s sick role process.

  • 73.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Integrative Medical Biology. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Lindgren, Gerd
    Westman, Göran
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    "How could I even think of a job?"--Ambiguities in working life in a group of female patients with undefined musculoskeletal pain.1997In: Scand J Prim Health Care, ISSN 0281-3432, Vol. 15, no 4, p. 169-74Article in journal (Refereed)
  • 74.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Stensland, P
    Chapter 3. The illness experience.2002In: Chronic myofascial pain - a patient-centered approach., Oxford Medical Press Ltd: Oxford , 2002Chapter in book (Other academic)
  • 75.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Westman, Göran
    Lindgren, Gerd
    The meanings of pain: an exploration of women's descriptions of symptoms.1999In: Soc Sci Med, ISSN 0277-9536, Vol. 48, no 12, p. 1791-802Article in journal (Refereed)
  • 76.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Risberg, Gunilla
    Hamberg, Katarina
    Is qualitative research scientific, or merely relevant? Research-interested primary care and hospital physicians' appraisal of abstracts.2003In: Scand J Prim Health Care, ISSN 0281-3432, Vol. 21, no 1, p. 10-4Article in journal (Refereed)
  • 77.
    Johansson, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Risberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender bias in female physician assessments: Women considered better suited for qualitative research2002In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 20, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To analyse whether physician assessment of scientific quality is biased by gender. DESIGN: Two fictive research abstracts on back pain treatment were constructed, one with a quantitative and one with a qualitative design. Authorship was assigned to either a woman or a man. SUBJECTS: 1637 randomly selected Swedish physicians were asked to judge the scientific quality of the two designs in a structured assessment form. MAIN OUTCOME MEASURES: The assessments of 1364 abstracts (286 female and 394 male assessors) were analysed by chi-square test and logistic regression. RESULTS: The quantitative design was judged the same, regardless of the gender of the author or assessor. The qualitative design, however, was ranked as more accurate, trustworthy, relevant and interesting with a female author. Women assessors upgraded female authors more than male authors, while male assessors reflected no gender differences. Assessor speciality interacted with judgement; physicians in primary care appreciated the qualitative abstract more than hospital physicians did (OR 2.78; 95% CI 1.97-3.92). CONCLUSION: Gender seems to affect scientific evaluations. The results are worth considering in situations where research is judged and interpreted, in medical tutoring, research guidance, peer reviewing and certainly in forming evaluation committees for research funding.

  • 78.
    Johasson, Eva E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Konsultationen ur ett genusperspektiv.2004In: Kropp och genus i medicin. / [ed] Hovelius & Johansson, Studentlitteratur , 2004, p. 117-125Chapter in book (Other academic)
  • 79. Kristoffersen, Agnete E.
    et al.
    Stub, Trine
    Salamonsen, Anita
    Musial, Frauke
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gender differences in prevalence and associations for use of CAM in a large population study2014In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 14, article id 463Article in journal (Refereed)
    Abstract [en]

    Background: Self-reported use of Complementary and Alternative Medicine (CAM) varies widely from 10% to 75% in the general populations worldwide. When limited to use of a CAM provider 2% to 49% reported use is found. CAM use is believed to be closely associated with socio demographic variables such as gender, age, education, income and health complaints. However, studies have only occasionally differentiated CAM use according to gender. Therefore, the aim of the study presented here is to describe the prevalence of CAM use on the background of gender and to describe the specific characteristics of male and female users in the total Tromso 6 population.

    Methods: A total of 12,982 men and women aged 30-87 in the municipality of Tromso, Norway went through a health screening program and completed two self-administered questionnaires in 2007/2008. The questionnaires were developed specifically for the Tromso study and included questions about life style and health issues in addition to socio demographic variables.

    Results: A total of 33% of the participants reported use of any CAM within the last 12 months, women more often than men (42% and 24%, respectively). When limited to visits to a CAM provider, we found 17% use among women and 8% among men. The relationship between the demographic variables and being a CAM user differed significantly between men and women with regard to age, household income, and marital status. We did not find significant differences between men and women concerning education and self-reported health.

    Conclusions: Findings from this study suggest that the prevalence and associations for use of CAM differ between men and women concerning several socio demographic variables (age, education and household income). Neglect of women's health care needs in public health care may contribute to the fact that women to a higher degree than men turn to CAM and CAM products.

  • 80.
    Kristoffersson, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Andersson, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bengs, Carita
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Experiences of the gender climate in clinical training: a focus group study among Swedish medical students2016In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 16, article id 283Article in journal (Refereed)
    Abstract [en]

    Background: Research shows that medical education is characterized by unequal conditions for women and men, but there is a lack of qualitative studies investigating the social processes that enable and maintain gender inequalities that include both male and female students. In this focus group study, we therefore explored male aswell as female medical students’ experiences of the gender climate – i.e., how beliefs, values, and norms about gender were communicated – during clinical training and how the students dealt with these experiences.

    Methods: Focus group interviews were conducted with 24 medical students (nine men) at Umeå University, Sweden. The interviews were structured around personal experiences in clinical training where the participants perceived that gender had mattered. Data were analysed using qualitative content analysis.

    Results: The students described gender-stereotyped expectations, discriminatory treatment, compliments, comments, and demeaning jargon. Female students gave more personal and varied examples than the men.The students’ ways of handling their experiences were marked by efforts to fit in, for example, by adapting their appearance and partaking in the prevailing jargon. They felt dependent on supervisors and staff, and due to fear of repercussions they kept silent and avoided unpleasant situations and people rather than challenging humiliating jargon or supervisors who were behaving badly.

    Conclusions: Everyday communication of gender beliefs combined with students’ adaptation to stereotyped expectations and discrimination came across as fundamental features through which unequal conditions for male and female students are reproduced and maintained in the clinic. Because they are in a dependent position, it is often difficult for students to challenge problematic gender attitudes. The main responsibility for improvements, therefore, lies with medical school leadership who need to provide students and supervisors with knowledge about gendered processes, discrimination, and sexism and to organize reflection groups about the gender climate in order to improve students’ opportunities to discuss their experiences, and hopefully find ways to protest and actively demand change.

  • 81.
    Kristoffersson, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Diderichsen, Saima
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Verdonk, Petra
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Andersson, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    To select or be selected - gendered experiences in clinical training affect medical students' specialty preferences2018In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 18, article id 268Article in journal (Refereed)
    Abstract [en]

    Background: The literature investigating female and male medical students' differing career intentions is extensive. However, medical school experiences and their implications for professional identity formation and specialty choice have attracted less attention. In this study we explore the impact of medical school experiences on students' specialty preferences, investigate gender similarities and differences, and discuss how both might be related to gender segregation in specialty preference.

    Methods: In a questionnaire, 250 Swedish final-year medical students described experiences that made them interested and uninterested in a specialty. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that were compared quantitatively.

    Results: Similar proportions of women and men became interested in a specialty based on its knowledge area, patient characteristics, and potential for work-life balance. These aspects, however, often became secondary to whether they felt included or excluded in clinical settings. More women than men had been deterred by specialties with excluding, hostile, or sexist workplace climates (W = 44%, M = 16%). In contrast, more men had been discouraged by specialties' knowledge areas (W = 27%, M = 47%).

    Conclusions: Male and female undergraduates have similar incentives and concerns regarding their career. However, the prevalence of hostility and sexism in the learning environment discourages especially women from some specialties. To reduce gender segregation in specialty choice, energy should be directed towards counteracting hostile workplace climates that explain apparent stereotypical assumptions about career preferences of men and women.

  • 82.
    Larsson, Marie-Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Genusperspektivet behöver stärkas i case-undervisningen: Analys av fallbeskrivningarna på läkarutbildningen i Umeå2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 6, p. 415-418Article in journal (Refereed)
  • 83. Larsson, Marie-Louise
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    [The gender perspective should be strengthened in medical education. Analysis of case reports at the university of Umea]2007In: Lakartidningen, ISSN 0023-7205, Vol. 104, no 6, p. 415-418Article in journal (Refereed)
  • 84.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Admission into a helping plan: a watershed between positive and negative experiences in breast cancer2010In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 19, no 8, p. 806-813Article in journal (Refereed)
    Abstract [en]

    Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on predefined categories.Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs.Methods: Seventy-one patients treated with radition therapy were consecutively included and repeatedly interviewed about their experiences of health care. 'Critical incidents' where identified from the interviews and analysed due to the similarities-differences technique in grounded theory.Results: Four categories of needs where detected: 'access', 'information', 'treatment', and 'how approached'. These categories and their properties merged into a core category - 'admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to fina a 'safe haven' to attach to. Cancer patients' 'safe haven' can be described as 'a helping plan'. It is not the result of a separate patient-caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole.Conclusions: The presented model of patients needs as converging into 'admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own 'hoope work'.

  • 85.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Breast cancer experience through the body: A consecutive, six-year longitudinal study of 24 womenManuscript (preprint) (Other academic)
  • 86.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Critical incidents in contact with healthcare reflecting the needs of women with breast cancer2008In: Psycho-Oncology, 2008, p. S10-Conference paper (Other academic)
  • 87.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, p. 267-274Article in journal (Refereed)
    Abstract [en]

    Background: An increasing number of women survive breast cancer and a majority return to work. However, findings based on mean values may conceal individual processes that need to be better understood to discuss meaningful rehabilitation.

    Aim: The purpose of this paper is to describe the sick-leave pattern of a group of Swedish women with primary breast cancer but foremost to explore their ideas about what motivates and discourages their return to work.

    Method: Fifty-six women were repeatedly interviewed over a period of 18 to 24 months. Interview sections that clearly illustrated the women’s experiences and ideas about work were categorized using the comparative similarities-differences technique.

    Findings: The average length of sick leave was 410 days (range 0-942). Six months after the first day of sick leave, 29% worked at least their previous service grade. At 12 months, 55%, and at 18 months 57% did so. Those treated with chemotherapy had in average more than twice as large sick leave as those who did not. Three categories emerged. ‘Motives for not returning to work’ consists of four sub-categories: ‘I’m still too fragile to return to work’; ‘My workplace is a discouraging place’; ‘I took an opportunity to pause’ and ‘I’ve lost the taste for work’. ‘Motives for returning’ consists of two sub-categories: ‘Work generates and structures my everyday life’ and ‘I miss my workplace’. Finally, ‘Transition in work approach’ reflects a changed approach to work.

    Conclusion: The meaning of work varies over time, but first and foremost work was regarded as an important part of the healing process as it restores the disruption of everyday life. Guidelines cannot be reduced to a linear relationship with biomedical variables but the individual context of everyday life must be considered.

  • 88.
    Lilliehorn, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Kero, Anneli
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Breast Cancer Experience Through the Body: A Consecutive, Six-Year Longitudinal Study of 24 Women2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, p. 334-334Article in journal (Other academic)
    Abstract [en]

    BACKGROUND: Breast cancer is a disruptive s bodies in body experiences in a life context are not sufficiently acknowledged in breast cancer research. Due to the increasing number of breast cancer survivors, longitudinal studies that pay attention to long-term experiences of the body are of vital importance in order to gain knowledge valuable for rehabilitation initiatives. This study is a contribution.

    four women were consecutively included in a prospective project and repeatedly interviewed during 6 years from ending hospitalised treatment. The qualitative analysis was made by means of thematic narrative analysis. Out of the interviews individual narratives were constructed s body experience over time. The narratives were repeatedly read to identify possible common thematic elements across participants of how the body appeared to the women and to discern processes of how this developed over time. Three main processes were found in the analysis.

    RESULTS: Common to all women was to initially experience the body as surviving. Survival was key target and bodily complaints were thus measured and valued in favour of that. When back to a new everyday life after treatment five women quickly experienced their bodies as comprehensible. They had undergone a minimum of treatments. 19 women reported more complaints and experienced the body as broken, fragile and as incomprehensible. With time and regained function most came to experience their bodies as comprehensible. Three women, however, met with more bodily decline than they could reconcile, they eventually disassociated from their bodies.

    CONCLUSIONS: This study makes a unique contribution by mapping out how breast cancer patients experience and value their bodies over 6 years from ending hospitalised treatment. The findings are considered from a phenomenological perspective and reflect how the women “discovered” and handled their bodies as something they had, the bodies were seen as separated from themselves while altering and changing due to side effects. The processes of establishing liveable body relations differed depending on treatment impact and ability to incorporate body changes as part of themselves. The findings are discussed in relation to theories of bodynormativity and biographical continuity.

    RESEARCH IMPLICATIONS: The study clarifies that experiences and valuations of body alterations and side effects shifts over time. It indicates the importance of further studies to carefully consider this transition over time and interpret selfassessments of body experience in relation to treatment (on-going/completed) and overall life context (on sick-leave/working).

    CLINICAL IMPLICATIONS: This study highlights the impact of side effects, especially from endocrine treatment, on breast cancer patients’ everyday life. We find it reasonable to suggest that physicians take a quite humble stand when discussing the treatment options. In cases of massive side effects, it must be possible to end treatment without this causing excessive worries for disease progression.

  • 89.
    Lindström, Ulf H.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johansson, Eva E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Medical students' experiences of shame in professional enculturation2011In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 45, no 10, p. 1016-1024Article in journal (Refereed)
    Abstract [en]

    Context: Despite the intentions of caregivers not to harm, medical encounters may involve intimidation and induce emotions of shame. Reflection is a critical part of professional learning and training. However, the role of shame in medical education has scarcely been studied. The aim of this study was to explore medical students’ reflections on shame-related experiences in clinical situations and to examine how they tackled these experiences.

    Methods: A 24-credit course in Professional Development is held at the Medical School of Umeå University, Sweden. A 1-day seminar on the theme of shame, which involves individual reflections and group discussions, is held in term 9. Medical students were invited to individually consider and write down their memories of situations in which they had experienced shame in clinical encounters. Of a total of 133 students, 75 were willing to share their written reflections anonymously. Their essays were transcribed to computer text and analysed by means of qualitative content analysis.

    Results: Three themes emerged. These included: Difficulties in disclosing shame; Shame-inducing circumstances, and Avoiding or addressing shame. Initially, students experienced problems in recalling shameful incidents, but successively described various situations which related to being taken by surprise, being exposed, and being associated with staff imprudence. Students disclosed shame avoidance behaviours, but also gave examples of how addressing shame provided them with new insights and restored their dignity.

    Conclusions: Students’ reflections on shameful experiences elucidated the importance of attitudes, manners, standards and hierarchies in clinical situations. These are important issues to highlight in the professional enculturation of medical students; our emphasising of them may encourage medical teachers elsewhere to organise similar activities. Opportunities for mentoring medical students in tackling shame and adverse feelings, and in resolving conflict, are needed in medical curricula.

  • 90. Lindström, Ulf
    et al.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hamberg, Katarina
    [Professional development. Gradual introduction of the subject in medical education in Umeå]2008In: Lakartidningen, ISSN 0023-7205, Vol. 105, no 12-13, p. 909-13Article in journal (Refereed)
  • 91.
    Lindström, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Professionell utveckling: Så förs ämnet stegvis in i läkarutbildningen i Umeå2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 12-13, p. 909-913Article in journal (Refereed)
    Abstract [en]

    Since the early 90's a course called Professional Development (PD) runs through all terms of Medical School in Umeå. The course has continuously been reformed on the basis of course evaluations. Today there is a well-reasoned progression in the curricula to synthesize students' actual knowledge level, skills, and attitudes into professionalism. The teaching items and the pedagogical methods in PU all aim to develop the students' reflective stance, gender awareness, empathy, ethical reasoning and consultations skills. Taking communication as an example: During the first terms, theories and small-group training sessions are introduced. By clinical courses, students video-tape their own consultations and get structured feedback in tutor-guided groups. The last terms, role plays on difficult clinical situations are staged for training, but also to challenge attitudes on for instance ethnicity and sexuality. Finally, insights in communication theories and their applicability are examined in a written video case exam.

  • 92.
    Lundqvist, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Wennberg, Anna-Lena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Högberg, Ulf
    Uppsala, Sweden.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Reported dietary intake in early pregnant compared to non-pregnant women: a cross-sectional study2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 373Article in journal (Refereed)
    Abstract [en]

    Background: A woman's nutritional status before conception and during pregnancy is important for maternal health and the health of the foetus. The aim of the study was to compare diet intake in early pregnant women with non-pregnant women. Methods: Between September 2006 and March 2009, 226 women in early pregnancy were consecutively recruited at five antenatal clinics in Northern Sweden. Referent women (n = 211) were randomly selected from a current health screening project running in the same region (the Vasterbotten Intervention Program; VIP). We collected diet data with a self-reported validated food frequency questionnaire with 66 food items/food aggregates, and information on portion size, alcohol consumption, and supplement intake. Data were analysed using descriptive, comparative statistics and multivariate partial least square modelling. Results: Intake of folate and vitamin D from foods was generally low for both groups. Intake of folate and vitamin D supplements was generally high in the pregnant group and led to significantly higher total estimated intake of vitamin D and folate in the pregnant group. Iron intake from foods tended to be lower in pregnant women although iron supplement intake evened out the difference with respect to iron intake from foods only. Energy intake was slightly lower in pregnant women but not significant, a reflection of that they reported consuming significantly less of potatoes/rice/pasta, meat/fish, and vegetables (grams/day) than the women in the referent group. Conclusions: In the present study, women in early pregnancy reported less intake of vegetables, potatoes, meat, and alcohol than non-pregnant women. As they also had a low intake (below the Nordic Nutritional Recommendations) of folate, vitamin D, and iron from foods, some of these women and their unborn children are possibly at risk for adverse effects on the pregnancy and birth outcome.

  • 93. Lövgren, Malin
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Tishelman, Carol
    Clock time and embodied time experienced by patients with inoperable lung cancer2010In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 33, no 1, p. 55-63Article in journal (Refereed)
    Abstract [en]

    In this study, we explore how patients with inoperable lung cancer (LC) discuss their experiences of time, based on content analysis of open interviews with 35 patients 1 year after diagnosis, using Davies' distinction between "clock time" and "embodied time" as sensitizing concepts. Two interrelated themes were derived: (1) aspects related to the healthcare system, with 3 subthemes: waiting times in the healthcare system, limited time for patient-professional contact, and limited time for coordination of services, and (2) existential aspects, with subthemes: the future with LC and managing an uncertain and finite life with LC. Time could be experienced as problematic for these patients, when limited or lacking or through long periods of waiting, especially when these periods occurred without adequate preparation or information. This contributed to exacerbation of these patients' existing sense of uncertainty, their perception of care as impersonal and insecure, and their need to remain alert and act on their own behalf. Awareness of the seriousness of their disease and the prospect of a limited lifetime was described as increasing uncertainty about dying and fear of certain death. People also described efforts to constructively deal with their situation by reprioritizing their remaining time, having increased appreciation of some aspects of daily life, and living consciously in the present. This analysis suggests a collision between clock time, which steers the healthcare system, and embodied time, as experienced by individuals. Greater attention to psychosocial needs is suggested as one means of positively affecting patients' experiences of time and uncertainty.

  • 94.
    Lövgren, Malin
    et al.
    The Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, 23300, 141 83 Huddinge, Sweden; The Department of Health and Social Sciences, Högskolan Dalarna, 791 88 Falun, Sweden.
    Leveälahti, Helena
    The Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, 23300, 141 83 Huddinge, Sweden; Stockholms Sjukhem Foundation, Research & Development Unit/Palliative Care, Mariebergsgatan 22, 112 35 Stockholm, Sweden.
    Tishelman, Carol
    Stockholms Sjukhem Foundation, Research & Development Unit/Palliative Care, Mariebergsgatan 22, 112 35 Stockholm, Sweden; School of Nursing, Midwifery and Social work, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; The Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Berzelius väg 3, 171 77 Stockholm, Sweden.
    Runesdotter, Sara
    The Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, 23300, 141 83 Huddinge, Sweden; Stockholms Sjukhem Foundation, Research & Development Unit/Palliative Care, Mariebergsgatan 22, 112 35 Stockholm, Sweden.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Koyi, H
    The Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.
    Time spans from first symptom to treatment in patients with lung cancer: The influence of symptoms and demographic characteristics2008In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 47, no 3, p. 397-405Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cancer stage at diagnosis is the most important prognostic factor for lung cancer (LC), but most patients are diagnosed with advanced disease with many and intense symptoms. This study explores relationships between LC patients' first symptoms, symptoms triggering health care system (HCS) contact, demographic/clinical characteristics, and time spans in the care trajectory from first symptom(s) to treatment start.

    MATERIALS AND METHODS: Medical records were examined from all 314 patients diagnosed with primary LC in 2003 at a Department of Respiratory Medicine, in Stockholm Sweden. Descriptive analysis was used to examine symptoms and time spans in the care trajectory. Cox regression analysis was conducted to explore the influence of symptoms and demographic/clinical characteristics on the time spans.

    RESULTS: Tumor-specific symptoms led to HCS visits to a greater extent than did systemic symptoms, despite reports of weight loss, fatigue and appetite loss as common first symptoms. Minor differences between women and men were found regarding specific symptoms. The study confirms that the time spans from first symptoms reported to treatment start are extensive, exceeding Swedish national recommendations. A lump/resistance, neurological symptoms, appetite loss, hemoptysis and non-thoracic related pain were associated with significantly shorter time spans in the care trajectory. People >74 years old risked longer time span from first HCS visit to treatment start.

    CONCLUSION: This study indicates a need for a more efficient LC care trajectory. Elderly patients could be particularly vulnerable for longer time spans.

  • 95.
    Lövgren, Malin
    et al.
    The Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
    Tishelman, Carol
    Stockholms Sjukhem Foundation, Research & Development Unit/Palliative Care, Stockholm, Sweden; School of Nursing, Midwifery and Social work, The University of Manchester, Manchester, United Kingdom; The Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
    Sprangers, Mirjam
    Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Koyi, Hirsh
    The Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Symptoms and problems with functioning among women and men with inoperable lung cancer - A longitudinal study2008In: Lung Cancer, ISSN 0169-5002, E-ISSN 1872-8332, Vol. 60, no 1, p. 113-124Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to compare the prevalence and intensity of symptoms and problems with functioning between women and men with inoperable lung cancer (LC) during 3 months post-diagnosis. One hundred and fifty-nine patients completed the EORTC QLQ C-30+LC13 at three time points: close to diagnosis and prior to treatment, and one, and 3 months later. Descriptive cross-sectional analyses and longitudinal analyses using repeated measure ANOVA were conducted. These patients reported many and intense symptoms and problems with functioning. The most salient finding from the cross-sectional analysis was that women reported both more, and more intense problems with emotional functioning close to diagnosis. Statistically significant improvements over time were found in both men and women with regard to emotional functioning, dyspnea, insomnia, cough, pain in arm/shoulder, while physical functioning, fatigue, constipation, dysphagia, peripheral neuropathy and alopecia deteriorated significantly over time. The longitudinal analyses suggest that, with the exception of emotional functioning, gender differences were not only related to biological sex alone, but were also found to be related to other components of the patients' life situation, such as education, age, civil status and type of LC. Sensitivity to different symptom experiences and responses to those experiences between and within women and men is also necessary in the management of symptoms in patients with inoperable LC.

  • 96. Malterud, Kirsti
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Reventlow, Susanne
    Qualitative methods in PhD theses from general practice in Scandinavia2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 309-312Article in journal (Refereed)
    Abstract [en]

    Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox.

  • 97. Petersson, C
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Är det alltid bra med en diagnos?1999In: AllmänMedicin, Vol. 20, no 3, p. 76-77Article in journal (Other (popular science, discussion, etc.))
  • 98. Phillips, Susan P.
    et al.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Doubly blind: a systematic review of gender in randomised controlled trials2016In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 9, p. 1-18, article id 29597Article, review/survey (Refereed)
    Abstract [en]

    Background: Although observational data show social characteristics such as gender or socio-economic status to be strong predictors of health, their impact is seldom investigated in randomised controlled studies (RCTs).

    Objective & design: Using a random sample of recent RCTs from high-impact journals, we examined how the most often recorded social characteristic, sex/gender, is considered in design, analysis, and interpretation. Of 712 RCTs published from September 2008 to 31 December 2013 in the Annals of Internal Medicine, British Medical Journal, Lancet, Canadian Medical Association Journal, or New England Journal of Medicine, we randomly selected 57 to analyse funding, methods, number of centres, documentation of social circumstances, inclusion/exclusion criteria, proportions of women/men, and reporting about sex/gender in analyses and discussion.

    Results: Participants' sex was recorded in most studies (52/57). Thirty-nine percent included men and women approximately equally. Overrepresentation of men in 43% of studies without explicit exclusions for women suggested interference in selection processes. The minority of studies that did analyse sex/gender differences (22%) did not discuss or reflect upon these, or dismissed significant findings. Two studies reinforced traditional beliefs about women's roles, finding no impact of breastfeeding on infant health but nevertheless reporting possible benefits. Questionable methods such as changing protocols mid-study, having undefined exclusion criteria, allowing local researchers to remove participants from studies, and suggesting possible benefit where none was found were evident, particularly in industry-funded research.

    Conclusions: Social characteristics like sex/gender remain hidden from analyses and interpretation in RCTs, with loss of information and embedding of error all along the path from design to interpretation, and therefore, to uptake in clinical practice. Our results suggest that to broaden external validity, in particular, more refined trial designs and analyses that account for sex/gender and other social characteristics are needed.

  • 99.
    Phillips, Susan P
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Queens University, Family Medciine, Kingston, Canada.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Women's relative immunity to the socio-economic health gradient: artifact or real?2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 27259Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Individual and area socio-economic status (SES) are significant predictors of morbidity and mortality in developed and developing countries. However, the span in health from poorest to richest, that is, the socio-economic gradient, appears steeper for men than women.

    OBJECTIVE: Our aim is to understand women's apparent immunity to the health harms of the SES gradient.

    DESIGN: Findings from a non-systematic search of Medline for population-based, SES gradient studies reporting results for both men and women and with health outcomes of morbidity, mortality or self-rated health (SRH) were reflectively analyzed.

    RESULTS: The 36 papers reviewed generally showed women to be relatively immune to the SES gradient for all but cardiovascular health outcomes. However, addressing the interconnected nature of socio-economic circumstances, exploring whether some measures of SES had ambiguous meanings for either women or men, including modifiers of SES such as household circumstances, social capital or area gender equity, or using indicators of area SES that were contextual rather than aggregates of individual, compositional measures increased the SES gradient for women. Outcome measures that combined mental and physical health, accounted for gender differences in SRH and adjusted for sex-specific differences in causes of mortality also explained some of the observed amelioration of the SES gradient among women.

    CONCLUSIONS: Socio-economic circumstances have a real and sustained impact on individual health. The SES gradient appears stronger for men than for women for all health outcomes other than heart disease. However, some of the observed variability between men and women may be an artifact of biased methodology. Considering webs of causation rather than individual markers of SES along with other sources of gender bias can explain much of women's blunted socio-economic gradient and deepen understanding of the pathways from SES to morbidity and mortality overall.

  • 100.
    Risberg, Gunilla
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hamberg, Katarina
    Johansson, Eva
    Gender awareness among physicians--the effect of specialty and gender. A study of teachers at a Swedish medical school.2003In: BMC Med Educ, ISSN 1472-6920, Vol. 3, p. 8-Article in journal (Refereed)
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