Although the therapeutic effect of the alliance between the social worker and the client is widely recognized, the knowledge on what actually constitutes a successful alliance is limited. The factors at stake are mostly referred to as common factors and include the ability of the social worker to be warm, personal, caring and devoted towards the client. With a bidirectional perspective on the construct of agency Ester Goh (2015) among others has shown that the relationship between the social worker and the client could be regarded as a resource for therapeutic success that enable the client to bean active agent in the process in his or her process of change. The aim of this study is to increase the understanding of what resources a successful relationship between a socialworker and a young client carries in the respect of enabling agentic behavior in the young client. Method In a collaboration with a drug prevention program in the municipality of Ale in the south-western part of Sweden, young clients in the age between 14 and 18 will be interviewed together with their social worker regarding their mutual relationship. Rather than addressing the social issues, the interview will focus on the relationship as such in search for the narratives of the nature of their relationship. Each paired interview will be followed up by individual interviews with the social worker and the young client respectively. Expected results The study is expected to expand the knowledge on how social workers establish functional relationship with young clients, relationships that in turn represents an important resource for the voice of the young client in his or her own process of change.

A principal element in the process of integration is identity. The ability of immigrants to integrate the cultural identity of their country of origin and the cultural identity of their new country to form a coherent self-concept has been found to be positively related to various forms of psychological well-being. But there is a lack of consensus among researchers regarding the optimal integrated identity structure. While supporters of the acculturative approach argue that a strong identification to both the original and the new groups maximizes well-being,others insist more on the importance of maintaining a coherent identity, regardless of the strength of identification and regardless of the number of social identities.As most researchers in the health oriented debate on identity have focused on abicultural context, knowledge of the identity structure that promotes well-being in a multicultural surrounding is limited. The identity politics dominating mainstream multicultural discourses are theoretically grounded on the idea that humans have essential, unchanging cores that are fully formed and integrated. Within this paradigm, groups are identified by characteristics that are understood as inherently distinctive. Therefore in order to understand the process by which social identities become integrated into a concept of self an intercultural approach of the understanding of social identities and well-being is suggested. The aim of this chapter is to review the debate on the concept of coherence in relation to identity and well-being in a multicultural context and to investigate whether identity based coherence is challenged or promoted by an intercultural approach of understanding.

In order to increase the understanding on whatdetermines health among immigrants, ethnic minoritiesand indigenous people concepts as acculturation, identityand sense of coherence (SOC) have become centralfor the analysis. The process of acculturation and theassociated concepts of integration, assimilation,marginalization and separation have often been referredto when describing the health of immigrants andindigenous, of which integration has been considered toprovide the better conditions for good health. The aim ofthis study is to explore the mutual relations between theconcepts of acculturation, SOC and identity by an abductivereasoning based on an investigation on a group ofSami regarding their cultural and ethnic self‐identification.By this explorative approach the study also seek totouch upon some of the relevant neighboring conceptssuch as cultural memory and position them among themore established social determinants of health. Thestudy demonstrates that coherence as a psychosocialcharacteristic is appearing in different concepts andmodels in the area of acculturation and cognitivedevelopment as well as in cultural memory. It has anintra‐individual dimension expressed in the theories ofcognitive development and cultural memory and interindividual,social dimension noticeable in SOC and theprocess of acculturation. The mutual correspondence ofthese structures of thought, values and perspectiveshave yet to be clarified and understood, especially inrelation to health.

The project "Health care interaction" among different care providers was introduced as a trial activity in the municipalities of Strömstad and Tanum in the spring of 2010. The aim of health care interaction is to provide citizens health care adapted to their specific need within shortest possible time frame; Is emergency care not needed, the aim is to avoid that the care seeker ends up in an emergency room at the hospital. In this study experiences from health care interaction is described with quantitative as well as qualitative data. Empirical data is based on available medical statistics, focus group interviews with nurses with long experience from pre-hospital emergency care and home health care, questionnaires data gathered from other health professionals involved in the activity, individual interviews with nurses and physicians at call centers for medical information, primary health care centers, home health care, pre-hospital health care and elderly care. The analysis of the data reveal opportunities and expectations among the personnel as well as their willingness to develop and improve the health care. It's also evident that the general impression among health care personnel is that increased interaction among health care providers improves the quality of the health care given. Health care interaction also contributes to improved opportunities for person-centered care with an increased degree of continuity and participation for the patient. The study also reveals that collaboration between colleagues promotes development of individual and collective knowledge. Conclusions drawn from the study is that the documentation and information system used in health care interaction needs to strengthen the participation of the care seekers as well as to improve in accessibility for the personnel involved. In order for health care interaction to evolve and develop through close follow-up and evaluation, a more transparent and uniform system for documentation is recommended. It's also concluded from the study that the call center for medical information (1177) as one of the major actors in the health care interaction program has the best potential to instigate an expansion and development of the health care interaction among care providers.

Objective Stomach cancer is a leading cause of cancer death, especially in developing countries. Incidence has been associated with poverty and is also reported to disproportionately affect indigenous peoples, many of whom live in poor socioeconomic circumstances and experience lower standards of health. In this comprehensive assessment, we explore the burden of stomach cancer among indigenous peoples globally.Design The literature was searched systematically for studies on stomach cancer incidence, mortality and survival in indigenous populations, including Indigenous Australians, Maori in New Zealand, indigenous peoples from the circumpolar region, native Americans and Alaska natives in the USA, and the Mapuche peoples in Chile. Data from the New Zealand Health Information Service and the Surveillance Epidemiology and End Results (SEER) Program were used to estimate trends in incidence.Results Elevated rates of stomach cancer incidence and mortality were found in almost all indigenous peoples relative to corresponding non-indigenous populations in the same regions or countries. This was particularly evident among Inuit residing in the circumpolar region (standardised incidence ratios (SIR) males: 3.9, females: 3.6) and in Maori (SIR males: 2.2, females: 3.2). Increasing trends in incidence were found for some groups.Conclusions We found a higher burden of stomach cancer in indigenous populations globally, and rising incidence in some indigenous groups, in stark contrast to the decreasing global trends. This is of major public health concern requiring close surveillance and further research of potential risk factors. Given evidence that improving nutrition and housing sanitation, and Helicobacter pylori eradication programmes could reduce stomach cancer rates, policies which address these initiatives could reduce inequalities in stomach cancer burden for indigenous peoples.

OBJECTIVES: The Roma people have been known in Europe for a 1000 years, during which they have usually been the subject of discrimination and oppression leading to isolation, powerlessness and poor health. The objective of this study is to investigate the sense of coherence (SOC) in relation to self-reported health among a group of Roma people in southwest Sweden.

STUDY DESIGN: A cross-sectional, quantitative pilot study.

METHODS: A questionnaire was constructed based on the Short-Form Health Survey (SF-12) and Antonovsky's Sense of Coherence Scale (SOC-13) and was distributed among Roma people in southwest Sweden (n =102). Self-reported health was summarised in a physical score (PCS) and a mental score (MCS). Comparisons were made with a general Swedish majority population and a Sami population.

RESULTS: The health scores were significantly lower among the Roma people compared to Swedes - PCS: Roma 46.0 (Swedes 52.0) and MCS: Roma 47.5 (Swedes 52.6). The SOC score for the Roma people (54.4) was significantly lower than that of the Swedes (65.2) and Sami (65.0).

CONCLUSIONS: The low SOC with the Swedish majority society is a strong indication of the marginalisation and exclusion of the Roma people from mainstream society. Low scores in self-reported health among the Roma people also establishes the serious health risks the Roma people are experiencing through their present life situation.

Objectives. Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families. Study design. The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001. Methods. An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail. Results. Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims. Conclusions. The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.