Living in the shadow of unemployment -an unhealthy life situation: a qualitative study of young people from leaving school until early adult life.

BACKGROUND: Despite the magnitude of youth unemployment there is a lack of studies, which explore the relations between health experiences and labour market position in various contexts. The aim of this paper was to analyse health experiences among young people in NEET (not in education, employment or training) in relation to labour market position from leaving school until early adult life. METHOD: The population consists of everyone (six women, eight men) who became unemployed directly after leaving compulsory school in a town in Northern Sweden. Repeated personal interviews were performed from age 16 until age 33. The interviews were analysed using qualitative content analysis. RESULTS: Health experiences can be viewed as a contextual process, related to the different phases of leaving school, entering the labour market, becoming unemployed and becoming employed. Perceived relief and hope were related to leaving compulsory school, while entering the labour market was related to setbacks and disappointments as well as both health-deteriorating and health-promoting experiences depending on the actual labour market position. Our overarching theme of "Living in the shadow of unemployment - an unhealthy life situation" implies that it is not only the actual situation of being unemployed that is problematic but that the other phases are also coloured by earlier experiences of unemployment . CONCLUSION: A focus on young people's health experiences of transitions from school into the labour market brings a new focus on the importance of macroeconomic influence on social processes and contextualised mechanisms from a life-course perspective.

Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review.

BACKGROUND: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls. METHODS: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. RESULTS: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. CONCLUSION: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.

Engagement in New Dietary Habits-Obese Women's Experiences from Participating in a 2-Year Diet Intervention.

BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time. PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention. METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles. RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase". CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

Experiences of barriers and facilitators to weight-loss in a diet intervention - a qualitative study of women in northern Sweden.

BACKGROUND: There is a lack of research about the experiences of participating in weight-reducing interventions. The aim of this study was to explore barriers and facilitators to weight-loss experienced by participants in a diet intervention for middle-aged to older women in the general population in Northern Sweden. METHOD: In the intervention the women were randomised to eat either a Palaeolithic-type diet or a diet according to Nordic Nutrition recommendations for 24 months. A strategic selection was made of women from the two intervention groups as well as from the drop-outs in relation to social class, civil status and age. Thematic structured interviews were performed with twelve women and analysed with qualitative content analyses. RESULTS: The results showed that the women in the dietary intervention experienced two main barriers - struggling with self (related to difficulties in changing food habits, health problems, lack of self-control and insecurity) and struggling with implementing the diet (related to social relations and project-related difficulties) - and two main facilitators- striving for self-determination (related to having clear goals) and receiving support (from family/friends as well as from the project) - for weight-loss. There was a greater emphasis on barriers than on facilitators. CONCLUSION: It is important to also include drop-outs from diet interventions in order to fully understand barriers to weight-loss. A gender-relational approach can bring new insights into understanding experiences of barriers to weight-loss. TRIAL REGISTRATION: ClinicalTrials gov NCT00692536.

'I am afraid to make the damage worse'--fear of engaging in physical activity among patients with neck or back pain--a gender perspective.

RATIONALE: Neck and back pain are major public health problems in Western societies and cause considerable disability and health service use. Swedish women report more severe neck and back pain compared with Swedish men. Most studies on the aetiology of gender differences in pain deal with biological mechanisms, and less with the role of psychological and sociocultural factors. 'Pain beliefs' is a sociocultural factor and can be expressed in different ways among women and men. It is important to know what pain beliefs are held by neck and back pain patients, especially when medical guidelines recommend that back pain patients stay physically active. AIM: Exploring pain beliefs in relation to physical activity among neck and back pain patients consulting primary health care. METHOD: Twelve patients (seven women, five men) consulting primary health care for an initial episode of neck or back pain were interviewed before their first appointment with a physiotherapist or general practitioner and 3 months later. The interviews covered patient experiences of neck or back pain, consequences, strategies and treatment experiences. The interviews were analysed with qualitative content analysis from a gender perspective. RESULT: One theme 'Fear of hurting the fragile body' was expressed by all neck or back pain patients. Five categories were identified 'The mechanical body', 'Messages about activity', 'Earlier experiences of pain and activity', 'To be a good citizen' and 'Support to be active' supported or undermined beliefs about pain and physical activity. Gender expressions occurred in the categories 'Messages about activity', 'To be a good citizen' and 'Support to be active'. CONCLUSIONS: Neck or back pain patients in the study saw the body as fragile and were afraid of hurting it. Notions of gender had an impact on the given advice about activity and on how patients perceived the message about staying active.

Perceived gender inequality in the couple relationship and musculoskeletal pain in middle-aged women and men.

AIMS: Musculoskeletal pain is a major health problem, especially in women, and is partially determined by psychosocial factors. The aim of the present study was to investigate whether gender inequality in the couple relationship was related to musculoskeletal pain. METHODS: Participants (n=721; 364 women and 357 men) were all individuals living in a couple relationship in the Northern Swedish Cohort, a 26-year Swedish cohort study. Self-administered questionnaire data at age 42 years comprised perceived gender inequality in the couple relationship and musculoskeletal pain (in three locations, summarised into one score and median-split), concurrent demographic factors, psychological distress, and previous musculoskeletal pain at age 30 years. Associations were examined using logistic regression. RESULTS: Gender inequality was positively associated with symptoms of musculoskeletal pain in the total sample, remaining significant after addition of possible confounders and of previous musculoskeletal pain. Separate adjustment for concurrent psychological distress attenuated the association but not below significance. The association was present and of comparable strength in both women and men. CONCLUSIONS: Gender inequality in the couple relationship might contribute to the experience of musculoskeletal pain in both women and men. The results highlight the potential adverse bodily consequences of living in unequal relationships.

Personal resources and support when regaining the ability to work: an interview study with Exhaustion Disorder patients.

PURPOSE: The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. METHODS: Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. RESULTS: A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. CONCLUSIONS: Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.

Gender analysis of musculoskeletal disorders and emotional exhaustion: interactive effects from physical and psychosocial work exposures and engagement in domestic work.

The objective of this study was to assess the relationships between physical and psychosocial work exposures, engagement in domestic work and work-home imbalance in relation to symptoms of musculoskeletal disorders and emotional exhaustion in white- and blue-collar men and women. Three thousand employees from 21 companies were asked to answer a questionnaire on family structure, household and child care tasks, work exposure, work-home imbalance and symptoms of neck/shoulder disorders, low back disorders and emotional exhaustion. Women reported more musculoskeletal disorders and engagement in domestic work. Adverse at-work exposures were highest in blue-collar women. High engagement in domestic work was not separately associated with symptoms but paid work exposure factors were associated. High engagement in domestic work interacted with adverse work exposure and increased risk estimates for low back disorders and emotional exhaustion. Reported work-home imbalance was associated with neck/shoulder disorders in women and with emotional exhaustion in both women and men. PRACTITIONER SUMMARY: The current article adds to earlier research by showing that high engagement in domestic work is not separately associated with increased symptoms, but interacts with psychosocial work exposure variables to produce emotional exhaustion in both women and men and low back disorders in women.

Upper arm postures and movements in female hairdressers across four full working days.

OBJECTIVES: To describe upper arm postures and movements among female hairdressers, including the variability between hairdressers, between days within hairdresser, and between tasks, as a basis for understanding the characteristics of exposures in the job, considering possible sources of variation and recovery, and discussing appropriate exposure assessment strategies. METHODS: Data on upper arm postures were collected using inclinometers during four working days the same week from 28 female hairdressers working in 13 salons. Twenty of the hairdressers noted customer on and off times in a diary, to allow separate analyses of customer tasks (CT) and auxiliary non-customer tasks (AT), including breaks. For a number of posture and movement variables, mean values and variance components between subjects (BS) and within subjects between days (BD) were estimated using restricted maximum likelihood algorithms in one-way random effect models. RESULTS: For the 20 hairdressers with diaries, CT accounted for 279 min (58%) (SD(BS) = 39 min and SD(BD) = 85 min) of the working day and AT and breaks for 207 min (42%) (SD(BS) = 46 min and SD(BD) = 88 min). The hairdressers worked with the right arm elevated >60 degrees for 6.8% of the whole job (SD(BS) = 2.8% and SD(BD) = 2.0%). On average, the hairdressers worked with the right arm elevated >60 degrees for 9.0% of the time during CT, compared to 3.7% during AT, resulting in a contrast between tasks of 0.35. CONCLUSIONS: Hairdressers may be at risk for developing musculoskeletal disorders in the neck and shoulders due to a considerable occurrence of highly elevated arms, especially during CT. On the other hand, we do not find reasons to classify hairdressing as a job with too little variation. Posture variability between days within hairdressers was in the same order of magnitude as that between hairdressers, suggesting that 'typical' workdays do not exist. The exposure contrast between CT and AT for variables describing elevated arm postures indicates that for these variables a simple task-based approach for estimating job exposure could be successful.

Cognitively oriented behavioral rehabilitation in combination with Qigong for patients on long-term sick leave because of burnout: REST--a randomized clinical trial.

BACKGROUND: Despite an increase in the occurrence of burnout, there is no agreement on what kind of rehabilitation these patients should be offered. PURPOSE: Primary aim of this study was to evaluate effects on psychological variables and sick leave rates by two different group rehabilitation programs for patients on long-term sick leave because of burnout. Rehabilitation program A (Cognitively oriented Behavioral Rehabilitation (CBR) and Qigong) was compared with rehabilitation program B (Qigong only). METHOD: In a randomized clinical trial, 96 women and 40 men with a mean age of 41.6 +/- 7.4 years were allocated to one of the two rehabilitation programs. RESULTS: A per-protocol analysis showed no significant difference in treatment efficacy between the groups. Both groups improved significantly over time with reduced levels of burnout, self-rated stress behavior, fatigue, depression, anxiety, obsessive-compulsive symptoms, and sick leave rates. In an intention-to-treat analysis, patients in program A had fewer obsessive-compulsive symptoms and larger effect sizes in self-rated stress behavior and obsessive-compulsive symptoms compared to patients in program B. CONCLUSION: This study showed no differences in effect between CBR and Qigong compared with Qigong only in a per-protocol analysis. Both rehabilitation programs showed positive effect for patients with burnout.

Young students as participants in school health promotion: an intervention study in a Swedish elementary school.

OBJECTIVES: The aim was to analyse if young students could be substantive participants in a health-promoting school project. The specific aims were to analyse the changes the students proposed in their school environment, how these changes were prioritized by a school health committee and to discuss the students' proposals and the changes from a health and gender perspective. STUDY DESIGN: An intervention project was carried out in an elementary school with students (about 150) in Grades 1 through 6. The intervention included small-group discussions about health promoting factors, following a health education model referred to as "It's your decision." At the last of 6 discussions, the students made suggestions for health-promoting changes in their school environment. A health committee was established with students and staff for the purpose of initiating changes based on the proposals. METHODS: A content analysis was used to analyse the proposals and the protocols developed by the health committee. RESULTS: The analysis showed 6 categories of the students' proposals: social climate, influence on schoolwork, structure and orderliness, security, physical environment and food for well-being. Their priorities corresponded to the students' categories, but had an additional category regarding health education. CONCLUSIONS: Principles that guide promoting good health in schools can be put into action among students as young as those in Grades 1 through 6. Future challenges include how to convey experiences and knowledge to other schools and how to evaluate if inequalities in health because of gender, class and ethnicity can be reduced through the focus on empowerment and participation.

Use of the model of Inner Strength for analysing reflective interviews in a group of healthy middle-aged adults.

OBJECTIVE: Inner Strength has been described as a human resource that promotes well-being linked to health. The aim of this study was to explore how Inner Strength and its four dimensions are manifested in interviews in a group of middle-aged healthy women and men. METHODS: Retrospective reflective interviews with middle-aged healthy women (n = 5) and men (n = 4) selected from a population study were content analysed deductively. RESULTS: The following themes and their constituents were found in the respective dimensions of the Model of Inner Strength. Firmness: having a drive to act, being purposeful, having trust in one's competence, and having a positive view of life. Connectedness: being in community, receiving and giving support, and, receiving and giving care. Creativity: changing unsatisfactory life situations, seeing new opportunities, and realizing dreams. Stretchability: balancing between options, and extending oneself. CONCLUSIONS: Expressions that were interpreted as belonging to Inner Strength could be referred the different dimensions of Inner Strength. The Model of Inner Strength is suitable for analysing Inner Strength among middle-aged men and women. The findings indicate that Inner Strength can be identified in human beings' narratives if asked for.

Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden.

BACKGROUND: Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age. OBJECTIVE: The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical 'school-to-work-transition' period of the life course. METHODS: Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16-33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a 'remote' municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the 'caring state' with its particular focus on basic and secondary education, and women's participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period. RESULTS: The results are presented as the theme of 'constructing respectability from disfavoured social positions'. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity. CONCLUSIONS: Gender-sensitive interventions are needed to strengthen young women's further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.

Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention: A Qualitative Study.

BACKGROUND: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. AIM: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. METHODS: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. RESULTS: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. CONCLUSION: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.

"Struggle to obtain redress": Women's experiences of living with symptoms attributed to dental restorative materials and/or electromagnetic fields.

The aim of this study was to explore the experiences of illness and the encounters with health care professionals among women who attributed their symptoms and illness to either dental restorative materials and/or electromagnetic fields, despite the fact that research on health effects from dental fillings or electricity has failed to substantiate the reported symptoms. Thirteen women (aged 37-63 years) were invited to the study and a qualitative approach was chosen as the study design, and data were collected using semi-structured interviews. The analysis was conducted with a constant comparative method, according to Grounded Theory. The analysis of the results can be described with the core category, "Struggle to obtain redress," the two categories, "Stricken with illness" and "A blot in the protocol," and five subcategories. The core category represents the women's fight for approval and arose in the conflict between their experience of developing a severe illness and the doctors' or dentists' rejection of the symptoms as a disease, which made the women feel like malingerers. The informants experienced better support and confirmation from alternative medicine practitioners. However, sick-leave certificates from alternative medicine practitioners were not approved and this led to a continuous cycle of visits in the health care system. To avoid conflicting encounters, it is important for caregivers to listen to the patient's explanatory models and experience of illness, even if a medical answer cannot be given.

The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain - a literature review.

PURPOSE: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain. METHOD: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis. RESULTS: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations". CONCLUSIONS: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies. Implications for rehabilitation Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

Health and Masculinities Shaped by Agency within Structures among Young Unemployed Men in a Northern Swedish Context.

AIM: The aim of our paper was to explore expressions of life choices and life chances (aspects of agency within structures) related to power and experiences of health among early unemployed adolescent young men during the transition period to adulthood. These expressions of agency within structure were interpreted in the light of Cockerham's Health Lifestyles Theory. Furthermore, social constructions of masculinities were addressed in our analysis. METHODS: Repeated interviews with ten young men in a cohort of school leavers were analyzed with qualitative content analysis. RESULTS AND DISCUSSION: Cockerham's model was useful for interpreting our findings and we found disposition to act to be a crucial theoretical tool to capture the will and intentions of participants in relation to health. We developed the model in the following ways: structure and socialization were visualized as surrounding the whole model. Analyses of what enhances or restricts power are important. In addition to practices of health lifestyles, we added experiences of health as outcome as well as emotional aspects in disposition to act. We interpret our findings as constructions of masculinities within certain structures, in relation to choices, habitus and practices. CONCLUSIONS: Qualitative research could contribute to develop the understanding of the agency within structure relationships. Future studies need to pay attention to experiences of health among young people at the margin of the labor market in various milieus--and to analyze these in relation to gender constructions and within the frame-work of agency within structure.

Gender perspective on fear of falling using the classification of functioning as the model.

PURPOSE: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). METHODS: Community-dwelling people (n = 230, 75-93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question "Are you afraid of falling?". RESULTS were discussed with a gender relational approach. RESULTS: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. CONCLUSIONS: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to "Are you afraid of falling?" might be highly influenced by gendered patterns.

Fall risk awareness and safety precautions taken by older community-dwelling women and men--a qualitative study using focus group discussions.

INTRODUCTION: Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls. METHODS: A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively. FINDINGS: Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts. CONCLUSIONS: The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.

Pathological mechanisms implicated in localized female trapezius myalgia.

Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The aim of this study was to investigate the mechanisms involved in work-related myalgia. In 21 women (age, 38.7+/-5.5 years), muscle biopsies were obtained from the upper part of the trapezius and the morphologic and metabolic characteristics of muscle fibres were analyzed. The patients indicated the number of painful areas on a pain drawing and the intensity of pain was assessed using a visual analogue scale (VAS). Two groups were formed on the basis of the median values: lower pain level and higher pain level. Trapezius muscles were characterized by the large size of type I fibres and the low capillary to fibre area ratio for both type I and type IIA fibres. Patients with the highest pain scores had the lowest capillary to fibre area ratio for type I fibres (coefficient correlation r = -0.45 and P < 0.05). Moreover, the proportion of cytochrome c oxidase (COX)-negative fibres seen in the cross-sections was significantly higher in the group of patients which had the higher pain and more painful areas than in the group of patients with lower pain level and painful areas (P < 0.05). The significant increase (P < 0.05) of the size of the type I fibres in trapezius myalgia point to the special strain imposed upon type I muscle fibres during work tasks. Cytochrome oxidase c deficiency which is indicative of an energy crisis within muscle cells and the low capillary to fibre area ratio which might impair oxygen delivery and removal of metabolites in the working muscles are both associated with pain in the trapezius muscle.