Mehdiyar, Manijeh; Andersson, Rune; Hjelm, Katarina
outside of the infectious diseases clinics limited the access to the general health care system for HIV-positive migrants. Conclusions: The HIV-positive migrants appreciated the free access to antiviral therapy, but wished to have more time for patient–physician communications. The participants......Background: There is limited knowledge about human immunodeficiency virus (HIV)-positive migrants and their experiences in the Swedish health care system. It is necessary to increase our knowledge in this field to improve the quality of care and social support for this vulnerable group of patients....... Objective: The aim of this study was to describe the experiences of HIV-positive migrants and their encounters with the health care system in Sweden. Design: This is a Grounded Theory study based on qualitative interviews with 14 HIV-positive migrants living in Sweden, aged 29–55 years. Results: ‘A hybrid...
Nilsson, Lina; Eriksén, Sara; Borg, Christel
To describe and obtain a deeper understanding of social challenges and their influence on the implementation process when implementing Information systems in a Swedish health-care organisation. Despite positive effects when implementing Information systems in health-care organisations, there are difficulties in the implementation process. Nurses' experiences of being neglected have been dismissed as reasons for setbacks in implementation. An Institutional Ethnography design was used. A deductive content analysis was made influenced by empirically identified social challenges of power, professional identity and encounters. An abstraction was made of the analysis. Nineteen nurses at macro, meso and micro levels were interviewed in focus groups. Organisational levels are lost in different ways in how to control the reformation, how to introduce Information systems as reformation strategies and in how to translate new tools and assumptions that do not fit traditional ways of working in shaping professional identities. Different focus may affect the reformation of health-care organisations and implementation and knowledge processes. An implementation climate is needed where the system standards fit the values of the users. Nursing management needs to be visionary, engaged and work with risk factors in order to reform the hierarchical health-care organisation. © 2016 John Wiley & Sons Ltd.
Ehn, S; Agardh, A; Holmer, H; Krantz, G; Hagander, L
Global health education is increasingly acknowledged as an opportunity for medical schools to prepare future practitioners for the broad health challenges of our time. The purpose of this study was to describe the evolution of global health education in Swedish medical schools and to assess students' perceived needs for such education. Data on global health education were collected from all medical faculties in Sweden for the years 2000-2013. In addition, 76% (439/577) of all Swedish medical students in their final semester answered a structured questionnaire. Global health education is offered at four of Sweden's seven medical schools, and most medical students have had no global health education. Medical students in their final semester consider themselves to lack knowledge and skills in areas such as the global burden of disease (51%), social determinants of health (52%), culture and health (60%), climate and health (62%), health promotion and disease prevention (66%), strategies for equal access to health care (69%) and global health care systems (72%). A significant association was found between self-assessed competence and the amount of global health education received (pmedical students (83%) wished to have more global health education added to the curriculum. Most Swedish medical students have had no global health education as part of their medical school curriculum. Expanded education in global health is sought after by medical students and could strengthen the professional development of future medical doctors in a wide range of topics important for practitioners in the global world of the twenty-first century. © 2015 the Nordic Societies of Public Health.
Elisabeth Mangrio; Karin Persson
.... Because of that, it is crucial that immigrant children have access to ongoing health care. The aim of this study is to shed light on the experience of non-European immigrants with Sweden's Child Health Care system...
Anderson, O W
The evolution and current problems of the Swedish health services are placed in an international comparative perspective with other industrially developed democratic states as to cost control, distribution of facilities and personnel, management of waiting lists for services, and differences in use of services. All of these countries are experiencing the same aforementioned problems differing mainly in degree. It is suggested that Sweden as well as other countries needs to reconceptualize the meaning of equality of access relative to the apparent emergence of private insurance as waiting lists grow for quality of life procedures such as lens and hip replacement. A concept of a basic service for everybody and so-called luxury service for those who wish to buy it needs to be faced in political debate. It is clear that government is unable to finance and supply the range of demand of a consumption good represented by a modern medicine. In so far as Sweden has been regarded as a model it appears that no country is a model anymore. The complexities of a modern health service has overwhelmed all countries and can be regarded as a sublime loss of innocence.
Razavi, Monireh Farsi; Falk, Lars; Björn, Åke; Wilhelmsson, Susan
Refugees needing long-term health care must adapt to new healthcare systems. The aim of this study was to examine the viewpoints of nine refugees in a county in Sweden, with a known chronic disease or functional impairment requiring long-term medical care, on their contacts with care providers regarding treatment and personal needs. Semi-structured interviews with nine individuals and/or their next of kin. Inductive content analysis was used to identify experiences. ''Care organisations/resources'' and ''professional competence'' were the categories extracted. Participants felt cared for due to accessibility to and regular appointments with the same care provider. Visiting different clinics contributed to a negative experience and lack of trust. The staff 's interest in participants' lives and health contributed to a sense of professionalism. Most participants said the problems experienced were not related to their backgrounds as refugees. Many patients did not fully understand which clinic they were attending or the purpose of the care that the specific clinic provided. Some lacked knowledge of their disease. Health care was perceived as equal to other Swedish citizens and problems experienced were not explained by refugee backgrounds. Lack of information from care providers and being sent to various levels of care created feelings of a lack of overall medical responsibility.
This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...... of these reforms on public support for the welfare state.......This report presents the main characteristics of reforms in the Swedish health services, as exemplified by the "Stockholm Model" introduced in 1992 in Stockholm county. The author discusses the motives behind these reforms, the already-evident increases in costs that are occurring, and the effect...
In a study on the implementation of the Swedish Mental Health reform in the county of Gavleborg in Sweden, attention was called, at an early stage, to the need for relevant theories on the nature of the obstacles that slowed down the reform process. Data had initially been gathered from interviews with persons from all levels of the implementation work. A Grounded Theory (GT) study was carried out using these data in order to generate a theory on the nature of the obstacles. Two separate analyses were made, one based on data from experts and decision makers and the other based on data from consumers and staff. Each of these analyses generated a theory with great explanatory and predictive value. In a further analysis, it became possible to merge the theories into an expanded theory with a greater general validity within the entire field of the Swedish Mental Health reform process. The expanded theory states that the psychiatric reform in Sweden is slowed down by obstacles preventing the transfer of information: 1) between staff in the mental health services and staff in the social services; 2) between social services' care givers and consumers. One reason for not removing these obstacles is that they serve an important purpose for those involved, in terms of preserving group identity, which gives them the opportunity to exert influence on their situation and provides room for manoeuvring.
Lundqvist, Peter; Svennefelt, Catharina Alwall
In Sweden there is a joint focus on injury prevention in agriculture and this is coordinated through the Swedish Committee on Working Environment (LAMK). LAMK is a network working for a good, healthy and safe working environment in Swedish agriculture from the view of the enterprise with the humans in focus. It is a committee consisting of representatives of authorities, institutions, companies, research & education institutions and organisations referring to the green sector. Examples of on-going initiatives & partners are presented which are included in this mission against injuries in agriculture. It involves the Swedish Work Environment Authority,, the Federation of Swedish Farmers (LRF), the Swedish Institute of Agricultural and Environmental Engineering, Swedish University of Agricultural Sciences (SLU, the Federation of Swedish Forestry and Agricultural Employers (SLA) and the Swedish Municipal Worker's Union.
Gunnarsson, Kristina; Andersson, Ing-Marie; Josephson, Malin
Small-scale enterprises are less often covered by occupational health services and have insufficient awareness about health and risks in the work environment. This study investigated how Swedish entrepreneurs in small-scale enterprises use occupational health services. The study used a questionnaire sent in two waves, 5 years apart. At baseline, 496 entrepreneurs responded, and 251 participated 5 years later. The questionnaire included items about affiliation with and use of occupational health services, physical and psychosocial work environments, work environment management, sources of work environment information, and membership in professional networks. Only 3% of entrepreneurs without employees and 19% of entrepreneurs with employees were affiliated with an occupational health service. Entrepreneurs affiliated with occupational health services were more active in work environment management and gathering information about the work environment. The occupational health services most used were health examinations, health care, and ergonomic risk assessments. Affiliation with occupational health services was 6% at both measurements, 4% at baseline, and 10% 5 years later. 2011, SLACK Incorporated.
Ostberg, Anna-Lena; Ahlström, Birgitta; Hakeberg, Magnus
The aim of this study was to generate new knowledge of considerations and factors having impacted the patients' choice of payment system and their views on oral health. Moreover, their later attitudes to the prepaid risk-related payment system, having been enrolled or not, were explored. A qualitative design was chosen and data was collected through semi-structured interviews.Twenty patients in the Public Dental Service (PDS) in western Sweden were strategically sampled with reference to gender, age (older/younger adults), residence (rural/urban), and choice of payment system:fee-for-service or capitation plan.The interview guide covered areas concerning the payment systems, patient considerations before choosing system, views of their own oral health and experiences of received dental care within the chosen system.The analysis was performed according to basic principles of qualitative content analysis. The results revealed two themes expressing the latent content. In the theme "The individual's relation to the PDS", expectations of the care, feelings of safety and aspects of responsibility emerged.The theme"Health-related attitudes and perceptions" revealed that views on health and self-assessment of oral health influenced the patients' considerations. Moreover, the perceived influence on oral health and risk thinking emerged as important factors in this theme. The conclusion was that the individual's relation to the PDS together with his/her health-related attitudes and perceptions were the main factors impacting the choice of payment system in the PDS. A health promotion perspective should be applied, empowering the patients to develop their risk awareness and their own resources.
Swedish public health policy clearly illustrates how the concept of the Ottawa Charter for health promotion can be utilized at a national level. The impact has been more implicit than explicit. Public health has a long history in Sweden and much of the present and future is, and will be, linked to traditional values and structures. International input, however, has been essential to prompt new approaches and change. Health inequalities remain the major shortcoming. The Swedish system offers universal access to healthcare in a decentralized system. Still, primary healthcare, and the health services as a whole have not yet sufficiently embraced the idea of health promotion. Political attention to modern public health at the Prime Minister level was established in late 1980s. Since, continuous initiatives in terms of organization, infrastructure and funding have taken place. With regard to funding, a vast majority of the resources allocated to health promotion will be found outside the health sector. An interesting observation is that the Swedish public health policy with its 11 objective domains remains the same, also after a change of government. Future challenges include maintaining and developing an intersectoral mechanism for implementation, allocating more resources for intervention research to strengthen knowledge-based health promotion, and developing tools for coping better with the challenges of globalisation identified in the Bangkok Charter.
Wångdahl, Josefin M; Mårtensson, Lena I
Health literacy (HL) is an important determinant for health and a valuable health indicator within public health. As such, it is a significant outcome variable of health promotion efforts. Valid and reliable instruments are needed to evaluate health promotion interventions and to assess levels of HL in a population. One of the few measurements of communicative and critical HL is the Japanese Communicative and Critical Health Literacy scale (C & C HL scale). To make it possible to use this instrument in Sweden, the C & C HL scale was translated into Swedish and different aspects of validity, including test-retest reliability, of the translated version were tested. After translation and back-translation, The Swedish C & C HL scale was tested for content validity and test-retest reliability. Data were collected from a committee consisting of public health experts and bilingual people, and from a test group of 35 persons. The Swedish C & C HL scale was understandable and showed evidence of content validity. The test-retest confirmed that it was stable over time, percentage agreements for the items ranging from 66% to 89% (M = 74%). The Swedish C & C HL scale is equivalent to the Japanese C & C HL scale in terms of language and content. The items cover the major aspects of communicative and critical HL and are understandable and stable over time, i.e., reliable.
Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese
Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Sweden has a long tradition of social democracy and corporate cooperation. Social problems are treated as technological questions that always should be solved through rational and neutral means. Today Sweden faces a crisis of economy as well as a crisis of medicine. In the spirit of consensus......, the state has proposed a new health reform emphasizing the responsibility of the public health service to prevent disease and provide equal access to care. It is claimed that improved health planning, based on epidemiological knowledge on inequalities, can solve the crisis in medicine within an improved...... system of primary care and prevention. However, in the context of the current economic crisis, the struggle against health hazards and cuts in public spending has intensified and the gap between the ideology of technological rationalism and reality has widened....
Perroca, Marcia Galan; Ek, Anna-Christina
The purpose of this paper was to describe the organization of the Advanced Home Care Program provided in a region of Sweden and to discuss some benefits and implications of this model adoption in Brazilian settings. Data triangulation as interview, observation and questionnaire was used. Thirty two professionals participated in this study. The organizational structure, working method, home visits, and related health resources were described. The investigated model presented both clear effectiveness and versatility; therefore feasible to be adopted in Brazilian settings improving their population health care. Doubtless, the improvement of life quality and security are the best benefits this model of care can provide.
In 2005 the Swedish government identified the need of common development of information and communication technology in health and social care. The purpose of this paper is to describe nurses' contribution to the establishment of a national cooperation concerning eHealth development in health and social care. The Swedish strategy of eHealth have six actions areas eServices for accessibility and empowerment, Usable and accessible information (for staff), Knowledge management, innovation and learning, Creating a common technical infrastructure, Creating a common information structure and Bringing laws and regulations into line with extended use of ICT. Nurses are involved in all action areas and emphasize the empowerment and safety of the patient and account of ethical values. Patients' possibility to take part of the information and adding information in their own patient health record, nurses' education and safe IT support in medication are areas that need further development.
Linell, Anita; Richardson, Matt X; Wamala, Sarah
In 2003, the Swedish Parliament adopted a cross-sectorial national public health policy based on the social determinants of health, with an overarching aim--to create societal conditions that will ensure good health, on equal terms, for the entire population--and eleven objective domains. At that time the policy was globally unique, and serves as guidance for public health practice at the national, regional and local levels. The development of the public health policy and the determinants of health are presented regularly in various reports by the Swedish National Institute of Public Health. This supplement is a condensed version of the 174-page Public Health Policy Report 2010, the second produced since the national policy was adopted in 2003. In order to provide a holistic approach to analysing implemented measures and providing new recommendations within the eleven objective domains of the Swedish national public health policy, we have divided these in three strategic areas. These are: Good Living Conditions, Health-Promoting Living Environments and Living Habits, and Alcohol, Illicit Drugs, Doping, Tobacco and Gambling, each described in the respective introductions for Chapters 3-5. The production of the report was supported by a common analytical model that clarified the societal prerequisites for health in the eleven objective domains. These are factors that can be influenced by political actions in order to create a change. Economic analyses have also been developed to provide a priority basis for political decisions. Analyses of the development of public health determinants were based on data from the National Public Health Survey and data delivered from about 15 various national agencies. Measures that have been implemented between 2004 and 2009 are analysed in details, as the basis for new recommendations for future measures. The introduction describes Swedish public health policy in the new millennium and how it has developed, the role of the Swedish
Full Text Available Mary-Louise Jung1, Karla Loria11Division of Industrial Marketing, e-Commerce and Logistics, Lulea University of Technology, SwedenObjective: To investigate older people’s acceptance of e-health services, in order to identify determinants of, and barriers to, their intention to use e-health.Method: Based on one of the best-established models of technology acceptance, Technology Acceptance Model (TAM, in-depth exploratory interviews with twelve individuals over 45 years of age and of varying backgrounds are conducted.Results: This investigation could find support for the importance of usefulness and perceived ease of use of the e-health service offered as the main determinants of people’s intention to use the service. Additional factors critical to the acceptance of e-health are identified, such as the importance of the compatibility of the services with citizens’ needs and trust in the service provider. Most interviewees expressed positive attitudes towards using e-health and find these services useful, convenient, and easy to use.Conclusion: E-health services are perceived as a good complement to traditional health care service delivery, even among older people. These people, however, need to become aware of the e-health alternatives that are offered to them and the benefits they provide.Keywords: health services, elderly, technology, Internet, TAM, patient acceptance, health-seeking behavior
Jung, Mary-Louise; Loria, Karla
Objective: To investigate older people’s acceptance of e-health services, in order to identify determinants of, and barriers to, their intention to use e-health. Method: Based on one of the best-established models of technology acceptance, Technology Acceptance Model (TAM), in-depth exploratory interviews with twelve individuals over 45 years of age and of varying backgrounds are conducted. Results: This investigation could find support for the importance of usefulness and perceived ease of use of the e-health service offered as the main determinants of people’s intention to use the service. Additional factors critical to the acceptance of e-health are identified, such as the importance of the compatibility of the services with citizens’ needs and trust in the service provider. Most interviewees expressed positive attitudes towards using e-health and find these services useful, convenient, and easy to use. Conclusion: E-health services are perceived as a good complement to traditional health care service delivery, even among older people. These people, however, need to become aware of the e-health alternatives that are offered to them and the benefits they provide. PMID:21289860
In the paper, some common questions and parallel development of ICT for eGovernment and eHealth in Sweden are discussed. In that context, front office and back office are two areas of information security development. Furthermore, information will be provided on "Catch 22" getting means for eIdentification and eSignature out to a large part of the population. Thereby, the catch of how to use a Government procurement of eIdentification and eSignature must be solved. The paper evaluates the lessons learned and current situation in Sweden for eServices, certificates and smart cards.
Full Text Available Nikolas Aho, Marie Proczkowska Björklund, Carl Göran Svedin Division of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden Abstract: The main objective of this article was to study the relationship between the different areas of victimization (eg, sexual victimization and psychological symptoms, taking into account the full range of victimization domains. The final aim was to contribute further evidence regarding the bias that studies that focus on just one area of victimization may be introduced into our psychological knowledge. The sample included 5,960 second-year high school students in Sweden with a mean age of 17.3 years (range =16–20 years, standard deviation =0.652, of which 49.6% were females and 50.4% males. The Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children were used to assess victimization and psychological problems separately. The results show that a majority of adolescents have been victimized, females reported more total events and more sexual victimization and childhood maltreatment, and males were more often victims of conventional crime. The majority of victimization domains as well as the sheer number of events (polyvictimization [PV] proved to be harmful to adolescent health, affecting females more than males. PV explained part of the health effect and had an impact on its own and in relation to each domain. This suggests the possibility that PV to a large degree explains trauma symptoms. In order to understand the psychological effects of trauma, clinicians and researchers should take into account the whole range of possible types of victimization. Keywords: victimization, childhood trauma, psychological symptoms, JVQ, TSCC
Svederberg, Eva; Wendin, Karin
Studies show frequent use of nutrition claims and health claims in consumers' choice of food products. The aim of the present study was to investigate how consumers' thoughts about these claims and food products are affected by various types of food-related experiences. The data collection comprised 30 individual interviews among Swedish consumers aged 25 to 64 years. The results indicated that participants who expressed special concern for their own and their families' health were eager to find out the meaning of concepts and statements made. A lack of understanding and lack of credibility of concepts and expressions often caused suspicion of the product. However, in some cases this was counterbalanced by confidence in manufacturers, retailers, and/or the Swedish food legislation. To achieve effective written communication of food products' health-conducive properties on food labels, there is a need to consider the importance many consumers attach to understanding the meaning of concepts and expressions used and the importance of credibility in certain expressions. Consumers' varying cognitive approaches are suggested as a basis for pre-tests of nutrition claims and health claims.
Jeansson, John S
At the very heart of Swedish healthcare digitalisation are large investments in electronic health records (EHRs). These integrated information systems (ISs) carry promises of great benefits and value for organisations. However, realising IS benefits and value has, in general, proven to be a challenging task, and as organisations strive to formalise their realisation efforts a misconception of rationality threatens to emerge. This misconception manifests itself when the formality of analysis threatens to underrate the impact of social processes in deciding which potential benefits to pursue. This paper suggests that these decisions are the result of a social process of negotiation. The purpose of this paper is to observe three benefits analysis projects of three Swedish hospitals to better understand the character and management of proposed benefits negotiations. Findings depict several different categories of benefits negotiations, as well as key factors to consider during the benefits negotiation process.
Jakobsson, Niklas; Persson, Mattias; Svensson, Mikael
This paper analyzes whether class size has an effect on the prevalence of mental health problems and well-being among adolescents in Swedish schools. We use cross-sectional data collected in year 2008 covering 2755 Swedish adolescents in ninth grade from 40 schools and 159 classes. We utilize different econometric approaches to address potential…
Summary of a GATEWAY report evaluation of a tunable LED lighting system installed in the new Swedish Medical Behavioral Health Unit in Seattle that incorporates color-tunable luminaires in common areas, and uses advanced controls for dimming and color tuning, with the goal of providing a better environment for staff and patients. The report reviews the design of the tunable lighting system, summarizes two sets of measurements, and discusses the circadian, energy, and commissioning implications as well as lessons learned from the project.
Mahapatra, Krushna; Gustavsson, Leif [Ecotechnology, Mid Sweden University, Akademigatan 1, 831 25 Oestersund (Sweden)
Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Oestersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey. (author)
Full Text Available Antibiotic resistance is a complex global health challenge. The recent Global Action Plan on antimicrobial resistance highlights the importance of adopting One Health approaches that can cross traditional disciplinary boundaries. We report on the early experiences of a multisectoral Sino-Swedish research project that aims to address gaps in our current knowledge and seeks to improve the situation through system-wide interventions. Our research project is investigating antibiotic use and resistance in a rural area of China through a combination of epidemiological, health systems and laboratory investigations. We reflect here on the challenges inherent in conducting long distance cross-disciplinary collaborations, having now completed data and sample collection for a baseline situation analysis. In particular, we recognise the importance of investing in aspects such as effective communication, shared conceptual frameworks and leadership. We suggest that our experiences will be instructive to others planning to develop similar international One Health collaborations.
Örnerheim, Mattias; Triantafillou, Peter
This article examines the development of diverse quality systems in the otherwise quite similar Danish and Swedish public health sectors. After decades of numerous piecemeal medical and managerial quality development programs in both countries, a nationwide mandatory accreditation system...... was introduced in the Danish health services in 2009. Nationwide quality indicator projects are also found in Sweden, but there has been political attempt to introduce a compulsory system. This article seeks to explain this difference. It argues, first, that resistance from the medical professions blocked...... the introduction of compulsory, nationwide quality systems in both countries for decades. Second, the implementation of the Danish accreditation system was triggered by a combination of unintended policy learning produced by local reforms in two counties and of the Ministry of Health’s carefully orchestrated...
Johansson, Helene; Weinehall, Lars; Emmelin, Maria
The role of health services must be re-oriented towards health promotion to more effectively contribute to population health. One of the objectives of the Swedish public health policy is that health promotion and disease prevention should be an integral part of the health care system and an important component of all care and treatment. However, the uncertainty about what the concepts of health and health promotion mean poses a challenge for implementation. Depending on how these concepts are interpreted, the attitudes of health professionals toward health promoting practices will differ. Thus, a more in-depth understanding of health professionals' views can be a starting point for a discussion about the values and attitudes that influence the current health care system and about the barriers and possibilities for future development of a health promoting health service. Seven focus group discussions (n = 34) were carried out with health professionals, from different health care settings, to understand how they communicate about health and health promotion. The data were analyzed using qualitative content analysis. The analysis of health professional's general understanding of the concept of health resulted in the category; a multi-facetted concept, whilst the category; a subjective assessment describes what health means to themselves. A third category; health is about life, the whole life. describes their understanding of health as an outcome of a multiplicity of contextually dependent determinants. The health professional's multiple ways of associating health promotion to disease prevention suggest a concept that is diffuse, elusive and difficult to apply in practice. Despite a shared view of health, the health professionals described their health promotion role very differently depending partly on how the concept of health promotion was interpreted. The analysis resulted in the development of three ideal types, labelled the demarcater, the integrater and the
Full Text Available Abstract Background The role of health services must be re-oriented towards health promotion to more effectively contribute to population health. One of the objectives of the Swedish public health policy is that health promotion and disease prevention should be an integral part of the health care system and an important component of all care and treatment. However, the uncertainty about what the concepts of health and health promotion mean poses a challenge for implementation. Depending on how these concepts are interpreted, the attitudes of health professionals toward health promoting practices will differ. Thus, a more in-depth understanding of health professionals' views can be a starting point for a discussion about the values and attitudes that influence the current health care system and about the barriers and possibilities for future development of a health promoting health service. Methods Seven focus group discussions (n = 34 were carried out with health professionals, from different health care settings, to understand how they communicate about health and health promotion. The data were analyzed using qualitative content analysis. Results The analysis of health professional's general understanding of the concept of health resulted in the category; a multi-facetted concept, whilst the category; a subjective assessment describes what health means to themselves. A third category; health is about life, the whole life. describes their understanding of health as an outcome of a multiplicity of contextually dependent determinants. The health professional's multiple ways of associating health promotion to disease prevention suggest a concept that is diffuse, elusive and difficult to apply in practice. Despite a shared view of health, the health professionals described their health promotion role very differently depending partly on how the concept of health promotion was interpreted. The analysis resulted in the development of three ideal
Wilkerson, Andrea [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Davis, Robert G. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Clark, Edward [ZGF Architects LLP, Seattle, WA (United States)
The GATEWAY program evaluated a tunable LED lighting system installed in the new Swedish Medical Behavioral Health Unit in Seattle that incorporates color-tunable luminaires in common areas, and uses advanced controls for dimming and color tuning, with the goal of providing a better environment for staff and patients. The report reviews the design of the tunable lighting system, summarizes two sets of measurements, and discusses the circadian, energy, and commissioning implications as well as lessons learned from the project.
Skär, Lisa; Söderberg, Siv
Objectives: Health is a central and important concept in nursing and nursing education, and has been theorised about in both positive and negative terms. The purpose of this study was to explore Swedish nursing students' perceptions of the concept of health. Design: A phenomenographic research approach was used to understand how nursing students…
Melin, Stefan A.
For electric utilities, the ability to prevent or minimize lightning damage on personnel and power systems is of great importance. Therefore, the Swedish State Power Board, has been using data since 1983 from a nationwide lightning location system (LLS) for accurately locating lightning ground strikes. Lightning data is distributed and presented on color graphic displays at regional power network control centers as well as at the national power system control center for optimal data use. The main objectives for use of LLS data are: supervising the power system for optimal and safe use of the transmission and generating capacity during periods of thunderstorms; warning service to maintenance and service crews at power line and substations to end operations hazardous when lightning; rapid positioning of emergency crews to locate network damage at areas of detected lightning; and post analysis of power outages and transmission faults in relation to lightning, using archived lightning data for determination of appropriate design and insulation levels of equipment. Staff have found LLS data useful and economically justified since the availability of power system has increased as well as level of personnel safety.
Brereton, Nicholas; Pennington, Becky; Ekelund, Mats; Akehurst, Ronald
Celecoxib for the treatment of pain resulting from osteoarthritis (OA) was reviewed by the Tandvårds- och läkemedelsförmånsverket-Dental and Pharmaceutical Benefits Board (TLV) in Sweden in late 2010. This study aimed to evaluate the incremental cost-effectiveness ratio (ICER) of celecoxib plus a proton pump inhibitor (PPI) compared to diclofenac plus a PPI in a Swedish setting. The National Institute for Health and Care Excellence (NICE) in the UK developed a health economic model as part of their 2008 assessment of treatments for OA. In this analysis, the model was reconstructed and adapted to a Swedish perspective. Drug costs were updated using the TLV database. Adverse event costs were calculated using the regional price list of Southern Sweden and the standard treatment guidelines from the county council of Stockholm. Costs for treating cardiovascular (CV) events were taken from the Swedish DRG codes and the literature. Over a patient's lifetime treatment with celecoxib plus a PPI was associated with a quality-adjusted life year (QALY) gain of 0.006 per patient when compared to diclofenac plus a PPI. There was an increase in discounted costs of 529 kr per patient, which resulted in an incremental cost-effectiveness ratio (ICER) of 82,313 kr ($12,141). Sensitivity analysis showed that treatment was more cost effective in patients with an increased risk of bleeding or gastrointestinal (GI) complications. The results suggest that celecoxib plus a PPI is a cost effective treatment for OA when compared to diclofenac plus a PPI. Treatment is shown to be more cost effective in Sweden for patients with a high risk of bleeding or GI complications. It was in this population that the TLV gave a positive recommendation. There are known limitations on efficacy in the original NICE model.
Waehrens, Rasmus; Ohlsson, Henrik; Sundquist, Jan; Sundquist, Kristina; Zöller, Bengt
Few large-scale studies have examined the prevalence of irritable bowel syndrome (IBS) and the number of visits among IBS patients in a primary health care setting. The aim of this study was to assess the prevalence of IBS in primary health care in four Swedish counties. Another aim was to study the number of visits among the IBS patients. A register-based study. Setting. A primary health care database with information on patients from 71 primary health care centres in the Swedish counties of Stockholm, Uppsala, Värmland, and Gotland. The primary health care database contains individual-level data for 919,954 patients for the period 2001-2007. Main outcome measures. Prevalence of IBS diagnosis. 10,987 patients had a diagnosis of IBS, which corresponds to a prevalence of 1.2%. IBS was most common in the 25-44 years age group (37% of IBS patients); 71% of IBS patients were female, and 81% of IBS patients visited their GP six or more times, compared with 46% of non-IBS patients. However, 95% of the IBS patients visited their GP three times or fewer for IBS. The prevalence of IBS was low among Swedish primary health care patients. This might suggest that IBS patients are insufficiently diagnosed in Swedish primary health care.
Fioretos, M; Scherstén, B
The last few decades have seen great changes in health care and medical care in Greece, as well as in the Greek university system. A new law on health care and medical care has come into force, a new university hospital and new health centres have been built, and a faculty of medicine has been established at Heraklion in Crete. People are speaking of a change of paradigm. Simultaneous with the introduction of the new national health care system, the Department of Family and Social Medicine (DFSM) in Crete started a major project on public health, known as the Primary Health Care and Nutrition Programs (abbreviated as PPD). The purpose was to chart the state of health and living conditions of the Cretan population in the period 1986-1990. Cooperation in research and training began between DFSM and the Dalby Health Sciences Centre, Lund University in 1987. This was natural since there was a shared interest in research into family medicine and social medicine. In addition, a new Health Care Act had come into force in Sweden in 1982. The establishment phase of primary health care started in Sweden at the end of the 1960s. In the 1970s health centres were established, along with research and training in family medicine, in a way that is comparable in many respects to the situation in which Crete found itself a decade later. This paper concerns the organization and implementation of PPD and the research cooperation between Greek and Swedish institutions. This can be seen as an expression of the internationalization of research for which the two universities have striven.
Öberg, Ulrika; Orre, Carl Johan; Isaksson, Ulf; Schimmer, Robyn; Larsson, Håkan; Hörnsten, Åsa
Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care. © 2017 Nordic College of Caring Science.
Cesarini, David; Lindqvist, Erik; Östling, Robert; Wallace, Björn
We use administrative data on Swedish lottery players to estimate the causal impact of substantial wealth shocks on players' own health and their children's health and developmental outcomes. Our estimation sample is large, virtually free of attrition, and allows us to control for the factors conditional on which the prizes were randomly assigned. In adults, we find no evidence that wealth impacts mortality or health care utilization, with the possible exception of a small reduction in the co...
Mattsson, M; Möller, B; Lundberg, Ie; Gard, G; Boström, C
The aim was to translate, test, and describe aspects of reliability and validity of the Fatigue Severity Scale (FSS) in Swedish (FSS-Swe) in patients with systemic lupus erythematosus (SLE). Patients with stable SLE, low or moderate disease activity, and low organ damage were included. Forward and back translations of the FSS were performed. Construct validity was tested with 32 women using a first Swedish translation. Feasibility, ceiling and floor effects, internal consistency, test-retest reliability, and content validity were tested on a slightly modified final version of the FSS-Swe in a non-selected group of patients (n = 23). There were correlations (pVisual Analogue Scale (SLAM-VAS) (r(s) = 0.46); between the FSS-Swe and eight subscales of the Swedish 36-Item Medical Outcomes Study Short-Form Health Survey (SF-36) (r(s) = -0.41 to -0.65) and between the FSS-Swe and age (r(s) = -0.35). All patients answered all FSS-Swe questions at both test and retest. There was one ceiling effect in one question on one occasion. The Kolmogorov-Smirnov test indicated normal distribution. Cronbach's alpha was 0.94 and corrected item-to-total correlation exceeded 0.3. There were no significant systematic test-retest differences, and the median-weighted kappa coefficient was 0.75. Twenty patients understood the questions in FSS-Swe, 18 considered they were relevant, reflected their fatigue, and that none should be excluded. Five items were suggested to be included. The FSS-Swe supports construct validity, is feasible, has no important ceiling or floor effects, has satisfactory internal consistency, substantial test-retest reliability, and satisfactory content validity in the SLE patients studied. However, its sensitivity to change needs to be tested.
Borgvall, Jonathan; Lif, Patrik
.... The military research work presented here includes the three military administrations, FOI -- Swedish Defence Research Agency, FMV -- Swedish Defence Materiel Administration, and SNDC -- Swedish...
Wångdahl, Josefin; Lytsy, Per; Mårtensson, Lena; Westerling, Ragnar
The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual's ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual's competence in accessing, understanding, appraising and applying health information. Little is known about refugees' health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees' experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences. A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models. In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25-28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45-17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3
Anell, Anders; Glenngård, Anna H; Merkur, Sherry
Life expectancy in Sweden is high and the country performs well in comparisons related to disease-oriented indicators of health service outcomes and quality of care. The Swedish health system is committed to ensuring the health of all citizens and abides by the principles of human dignity, need and solidarity, and cost-effectiveness. The state is responsible for overall health policy, while the funding and provision of services lies largely with the county councils and regions. The municipalities are responsible for the care of older and disabled people. The majority of primary care centres and almost all hospitals are owned by the county councils. Health care expenditure is mainly tax funded (80%) and is equivalent to 9.9% of gross domestic product (GDP) (2009). Only about 4% of the population has voluntary health insurance (VHI). User charges fund about 17% of health expenditure and are levied on visits to professionals, hospitalization and medicines. The number of acute care hospital beds is below the European Union (EU) average and Sweden allocates more human resources to the health sector than most OECD countries. In the past, the Achilles heel of Swedish health care included long waiting times for diagnosis and treatment and, more recently, divergence in quality of care between regions and socioeconomic groups. Addressing long waiting times remains a key policy objective along with improving access to providers. Recent principal health reforms over the past decade relate to: concentrating hospital services; regionalizing health care services, including mergers; improving coordinated care; increasing choice, competition and privatization in primary care; privatization and competition in the pharmacy sector; changing co-payments; and increasing attention to public comparison of quality and efficiency indicators, the value of investments in health care and responsiveness to patients needs. Reforms are often introduced on the local level, thus the pattern of
Lundqvist, Peter; Alwall Svennefelt, Catharina
Occupational injuries are a major problem in agriculture world-wide. Sweden is developing a national approach to scoordinate different stakeholders with the common goal of reducing injuries in the agricultural sector. The Swedish strategy involves important factors, such as: 1) Collaboration between all stakeholders involved in health and safety in agriculture, 2) A national programme on injury prevention, 3) Coordination of actions and 4) Knowledge, attitude and behaviour in focus. This approach is being coordinated through the Swedish Committee on Working Environment (LAMK), a network acting to achieve a good, healthy and safe working environment in Swedish agriculture. The Committee consists of representatives of authorities, institutions, companies, research and education institutions and organisations working in the green sector. The Swedish model will be evaluated as a whole concept on its effect on the frequency of injuries in the agricultural industry in the beginning of 2014. Promising results has been shown in evaluations of minor parts. This coordinated approach has been applied in others countries (United States and New Zealand) as well and seems like an efficient way of using limited resources to achieve higher impact on a specific problems such as occupational injuries in agriculture.
Nilsson, Lina; Hofflander, Malin
eHealth is implemented in everyday work practice as a tool to improve accessibility and patient participation as well as healthcare efficiency. The aim of this study was to explore healthcare staff's experiences and ideas about how eHealth ought to be designed to be a useful tool in everyday work practice in a Swedish healthcare organization. Healthcare staff (n=7) at the micro level in a Swedish healthcare organization, participated in four Participatory Design workshops about eHealth design. eHealth could be a more useful and efficient tool in everyday work practice if it were designed more purposefully for its local setting and intended users, like the information system in 'a departure lounge of an airport'. Including healthcare staff in design discussions concerning eHealth tools for everyday work practice may improve the efficiency of eHealth as an everyday tool and support for healthcare staff.
Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described.......Sweden initiated a dental health care insurance in 1973. The health insurance is outlined, current problems and political issues are described. The benefits and limitations are described....
Full Text Available Abstract Background Possible accumulative effects of a combined economic hardship's measure, including both income and non-income related economic hardships measures, on mental health has not been well investigated. The aim of this paper was to investigate; (i independent associations between multiple measures of economic hardships and mental health problems, and (ii associations between a combined economic hardships measure and mental health problems. Methods We analysed data from the 2009 Swedish National Survey of Public Health comprising a randomly selected representative national sample combined with a randomly selected supplementary sample from four county councils and three municipalities consisting of 23,153 men and 28,261 women aged 16-84 years. Mental health problems included; psychological distress (GHQ-12, severe anxiety and use of antidepressant medication. Economic hardship was measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Results The results from multivariate adjusted (age, country of birth, educational level, occupational status, employment status, family status and long term illness logistic regression analysis indicate that self-reported current economic difficulties (inability to pay for ordinary bills and lack of cash reserves, were significantly associated with both women's and men's mental health problems (all indicators, while low income was not. In addition, we found a statistically significant graded association between mental health problems and levels of economic hardships. Conclusions The findings indicate that indicators of self-reported current economic difficulties seem to be more strongly associated with poor mental health outcomes than the more conventional measure low income. Furthermore, the likelihood of mental health problems differed significantly in a graded fashion in relation to levels of economic hardships.
Rose, G; Bengtsson, C
The records of 117 subjects, workers who had participated in a health examination at a Swedish industry, were studied retrospectively in order to find out which measures had been taken as a consequence of the results from the different examinations. The extensive laboratory examination programme that had been carried out seemed to be of limited value. It is concluded that the extensive examination programmes carried out in many industries should be re-evaluated more critically.
Full Text Available The general rule in EU law is that value-added tax (VAT is to be levied on all goods and services. There are a number of exceptions, however, one of which applies to certain medical services. This paper examines the legal basis for tax exemptions in EU VAT law and in Swedish law, with particular attention to the extent to which the rapidly growing private health-care sector is covered by these tax exemptions.
Amft, Martin; Leisvik, Mathias; Carroll, Simon
Half of the original 13 Swedish nuclear power reactors will be shut down by 2020. The decommissioning of these reactors is a challenge for all parties involved, including the licensees, the waste management system, the financing system, and the Swedish Radiation Safety Authority (SSM). This paper presents an overview of the Swedish regulations for decommissioning of nuclear facilities. It describes some of the experiences that SSM has gained from the application of these regulations. The focus of the present paper is on administrative aspects of decommissioning, such as SSM's guidelines, the definition of fundamental concepts in the regulatory framework, and a proposed revision of the licensing process according to the Environmental Act. These improvements will help to streamline the administration of the commercial nuclear power plant decommissioning projects that are anticipated to commence in Sweden in the near future. Copyright © 2017 Elsevier Ltd. All rights reserved.
Persson, Louise; Haraldsson, Katarina
Schools are recognized worldwide as settings for health promotion, and leadership has a bearing on schools' ability to be health promoting. School managers have a great influence on what is prioritized in school, which in turn affects students' school performance and health. There is lack of research into school managers' views on health promotion, and what they consider to be central to health promotion. The aim was therefore to examine school managers' views about what health promotion in schools include. An explorative design, qualitative content analysis, was performed. In-depth interviews were conducted with all 13 school managers of a middle-sized municipality in central Sweden. The analysis had both manifest and latent content and three categories: 'Organization and Collaboration', 'Optimize the arena' and 'Strengthen the individual', and 10 subcategories emerged. The theme, 'Opportunities for learning and a good life', describes the latent content of these categories. Taking into account the views of school managers are important because these views help form a more complete picture of how school managers work with health promotion and what is needed to enhance health promotion to improve students' opportunities for learning and a good life. The Ottawa Charter for Health promotion is thereby transformed into practice. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Isaksson, Pernilla; Marklund, Bertil; Haraldsson, Katarina
The promotion of childhood mental health is an important investment for the future. Many young children spend a large amount of time in preschool, which have unique opportunities to promote mental health at an early stage. The aim of this study was to illuminate teachers’ views of what they do in ordinary work to promote mental health among preschool children. This qualitative study had a descriptive and exploratory design and qualitative content analysis was utilized. Six focus group interviews with preschool teachers, concerning families from different cultural, geographical and socioeconomic backgrounds, were conducted in a county in the southwest of Sweden. Both manifest and latent content appeared. Three categories, ‘structured world’, ‘pleasant climate’ and ‘affirming the child’ and 10 subcategories emerged. The latent content of these categories is described under the theme ‘creating an atmosphere where each child can flourish in harmony with their environment’. The results show teachers different working approaches with mental health in preschool and together with previous research these results can provide a basis of knowledge for preschool teachers and inspire them to develop and maintain their health-promoting work. In future studies it should be particularly interesting to investigate how the promotive way to work can be transferred to strengthen mental health throughout the school years.
Eriksson, Ulrika; Hochwälder, Jacek; Carlsund, Asa; Sellström, Eva
The aim of the study was to explore the extent to which Swedish children's perceptions of social capital in the family, school and neighbourhood predicted health complaints and well-being. The study used data from the Swedish Health Behaviour in School-aged Children survey. The sample consisted of 3926 children aged 11-15 years. Correlations and hierarchical multiple linear regression were performed. Higher degrees of family, school and neighbourhood social capital corresponded to lower levels of health complaints and higher levels of well-being. Social capital in these three spheres had a cumulative effect on children's health and well-being. Social capital in the family, school and neighbourhood matters for children's health and well-being and the contributions from each context seem to be additive. Besides the family context, investments for improving child health should primarily be in the school, focusing on social relations and on creating safe and cohesive school environments. Neighbourhood social capital is also of importance and so must be taken into consideration when planning child health promotion interventions. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.
Johansson, Linda; Wijk, Helle; Christensson, Lennart
To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects. Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished. Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days. Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.
Full Text Available The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden. Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM and Porras and Robertson’s (1992 change model. : In both organizations, the view of Lean changed from a toolbox to a human behavior view. Eight barriers were experienced in both organizations. Three barriers were unique to manufacturing or to health care, respectively. Nine barriers were elements of social factors; five were elements of organizing arrangements. Only people practically involved and responsible for the implementation at the two organizations participated in the study. Persons responsible for implementing Lean should consider organizational arrangements and social factors in order to limit barriers to successful implementation. Most research on Lean has been about successful Lean implementations. This study focuses on how Lean is viewed and what barriers personnel in manufacturing and health care have experienced. In comparing the barriers to Lean experienced in the two groups, common, archetypical, and unique barriers for manufacturing and health care can be identified, thus contributing to knowledge about barriers to Lean implementation.
Back, Par-Erik; Lane, Jan-Erik
To analyze organizational development of Swedish universities and colleges, decision theory and implementation theory were examined. Attention was directed to the following models of decision-making: the demographic model, the incremental model, the garbage-can model, and the political model. The focus was on system decision-making, and empirical…
Cerrah Ozsevgec, Lale; Artun, Huseyin; Unal, Melike
This study was designed to examine the effect of Swedish Knife Model on students' understanding of digestive system. A simple experimental design (pretest-treatment-posttest) was used in the study and internal comparison of the results of the one group was made. The sample consisted of 40 7th grade Turkish students whose ages range from 13 to 15.…
Bengt Halling; Katarina Wijk
The purpose is to compare similarities and divergences in how the concepts of Lean and barriers to Lean are described by key informants at a production unit in a large manufacturing company and two emergency health care units in Sweden. Data was collected via semi-structured interviews and analyzed with the constant comparative method (CCM) and Porras and Robertson’s (1992) change model. : In both organizations, the view of Lean changed from a toolbox to a human behavi...
Dahlman, Disa; Stafström, Martin
According to previous studies, foreign travellers and backpackers are at increased risk of sexually transmitted infections (STI). Concurrently, STI incidence, especially Chlamydia, is increasing among young Swedes. Our objective was to investigate Swedish backpackers' own view of sexual health and risks while travelling, with the purpose to identify hypotheses for further, more extensive research. In-depth semi-structured interviews were carried out in Vietnam with four Swedish women in their early twenties. The interviewees had been travelling throughout South East Asia for a period of at least two weeks. There were large differences between the respondents regarding perceived health risks in relation to food safety, STI, and alcohol and drug use; and to what extent their behaviour while travelling deviated from their normal one. In contrast, the interviewees shared a perceived lack of knowledge about sexual health abroad. The study identified six hypotheses and suggestions for preventive measures that could be analysed in future research. The study demonstrated that sexual behaviour as well as attitudes and norms were strongly linked to the individual level, rather than to the group of backpackers. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Swedish democracy ranks very high in international democracy indexes. It fascinates political scientists from all over the world because it seems to have resolved a fundamental political dilemma: the choice between equality and liberty, without the historical inconvenient of regimes which favoured too much equality - but killed liberty, or regimes which favoured liberty - but failed to make citizens equal... The "'egalitarian pluralism" practiced in Swedish political system is rooted in a specific political culture. This culture has opted for popular sovereignty and comes from the ancient peasant society. Lutheran values and the absence of feudalism paved the way to the search for equality and the edification of a strong State. In the 20th century, the Social-democrats endorsed the traditional Swedish values and prolonged them in the so-called Swedish model, with social policies allowing more equality along with more individual autonomy. Nowadays, the model is evolving, coping with globalization, and the definition of equality is under discussion.
Berntsson, Leeni T; Ringsberg, Karin C
Three cross-sectional time series studies, randomised and stratified for age and gender, were performed on children aged 2-17, studying their health and well-being. The studies were performed in the Nordic countries in 1984, 1996 and 2011. Long-term illness (LTI) and psychosomatic complaints (PSC) increased during the period. Data were collected from mailed questionnaires. Data of 1461 Swedish children from 2011 were used and compared with data from 1984 and 1996. Relationships between the health indicators (the absence of LTI, 13 diagnoses, the absence of PSC, six symptoms, six items of well-being) and 12 activities were analysed. A total of 83.2% of the children were healthy and 16.8% had at least one LTI, boys 19.1% and girls 14.5%. PSC increased from 18.6% in 1996 to 23.1% in 2011. The distribution was higher in girls. Girls were more active than boys during leisure time. 'Reading books', 'visiting friends', 'listening to music' and 'activity in organisations' were related to an absence of PSC, LTI and well-being. 'Surfing/blogging on the Internet' was negatively related to LTI, PSC and well-being. Multiple regression showed that that 'visits or is visited by friends' was related with a low probability for LTI and also with a high probability for well-being. In the logistic regression analyses, the following variables were seen as promoting health most: 'visits or is visited by friends' and 'is active in organizations' for children aged 2-17 years, especially for boys and well-being. The health of Swedish children declined between 1984 and 2011. Positive relationships were found between some activities and health as well as other activities related to ill health. The results suggest an increased focus on the activities that have positive relationships with health in order to promote health among children. © 2013 Nordic College of Caring Science.
Nygren, Anders; Nordenfelt, Patrik; Lindfors, Anders; Mallbris, Lotus; Björkander, Janne; Wahlgren, Carl-Fredrik
Few studies have been published on children with hereditary angioedema (HAE), an autosomal dominant disease caused by mutations on chromosome 11. This study explored various aspects of the disease in the Swedish paediatric population. A retrospective questionnaire was sent to all 36 Swedish children known to have HAE, and a physician carried out follow-up telephone interviews. Most of the questionnaires were completed by the parents of 31 (86%) children with HAE, with or without their input, at a median age of nine years (range 1-17), and the physician also interviewed 29. HAE symptoms were experienced by 23 children, including abdominal attacks (96%), skin swelling (78%) and swelling in the mouth and/or upper airways (52%). Psychological stress was the most common trigger for abdominal attacks and trauma and sports triggered skin swelling. The majority (n = 19) had access to complement-1 esterase inhibitor concentrate at home. Current health and quality of life were generally rated as good, independent of whether the child had experienced HAE symptoms or not. Most children with HAE had experienced abdominal attacks and skin swelling, but their overall health and quality of life were generally perceived to be good. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Knutsson, David; Werner, Sven [Chalmers Univ. of Tech., Goeteborg (Sweden). Div. of Energy Systems Technology
Sweden has the second lowest carbon dioxide emissions per capita in the European Union, 28% below the EU average. The major explanation for this fact is the dominating resources of hydropower and nuclear power in the Swedish power generation. As the deregulation of the European electricity markets will continue, the electricity systems inside the Union will become more integrated. Hence, Sweden is merging into a carbon rich power generation system. Currently, the Swedish district heating sector has a very low national power-to-heat-ratio, which implicates that Sweden has great potential for additional electricity production in the existing district heating systems. This paper shows, that if the extension of the natural gas grid proposed in the Nordic Gas Grid project is realised, the annual potential for further natural gas based electricity production in the Swedish district heating systems is 26 TWh. In the short range, the corresponding carbon dioxide reduction in northern Europe is 16 M ton. This is approximately one quarter of the total annual carbon dioxide emissions in Sweden today.
Full Text Available The living conditions of young adults in Sweden have changed during the last decades due to the economic and employment situation in society. Although oral health is mainly considered to be good in this age group, their use of dental care has decreased and their priorities and opportunities regarding oral health are little known. The purpose of this study was to describe the views of Swedish young adults on their oral health and oral health-related quality of life (OHRQoL. The design of the study was qualitative, using content analysis. Sixteen young adults, aged 21–29 years, were interviewed. The findings from the interviews were summarized under the theme “Young adults reflected on their OHRQoL in a time perspective” consisting of three categories: “Past experiences, Present situation, and Future prospects.” The OHRQoL of young adults is dependent not only on their own experiences of oral health during childhood and their received dental care but also on their present self-perceived oral health, oral health habits, and social life; together with their expectations of future oral health. The findings in this study indicate that the oral health awareness and needs of young adults, as well as their expectations of oral care, merit further follow-up.
Seldén, A I; Berg, N P; Lundgren, E A; Hillerdal, G; Wik, N G; Ohlson, C G; Bodin, L S
Deposits of carbonate rock like limestone and dolomite may contain tremolite asbestos. This study assessed the exposure to tremolite asbestos and the respiratory health of Swedish dolomite workers. 95% of 137 eligible workers at two dolomite producing companies completed a self administered questionnaire that included questions on respiratory symptoms and were examined with spirometry as well as chest radiography. Total exposure to dust was gravimetrically measured and the tremolite asbestos content of the dust was assessed with polarisation and phase contrast microscopy. Dolomite dust concentrations were moderate (median 2.8 mg/m3) and tremolite asbestos concentrations were generally below the limit of detection (Dolomite mining and milling may indeed entail low levels of exposure to tremolite asbestos, but this exposure was not a strong determinant of respiratory symptoms, lung function, or pneumoconiosis in exposed Swedish workers. This was true also for dolomite dust. The hazards of exposure to tremolite asbestos may vary across deposits, however, and additional studies at other sites of carbonate rock exploitation are warranted.
Prioritisation of medical services in Sweden takes place on two different levels. On the national level, the Swedish priority guidelines ascribe priority values ranging from 1 (high priority) to 10 (low priority) to measures (in terms of condition-treatment pairs) of prevention, diagnosis, treatment and rehabilitation of cardiovascular diseases. In addition, this list contains interventions that should be avoided and those that should only be provided as part of clinical research projects. The government then commissions a multi-professional team under the supervision of the National Board of Health and Welfare "Socialstyelsen" with the development of corresponding guidelines. In addition to the scientific evidence, the priority lists incorporate ethical and economical aspects and are based on the so-called ethics platform consisting of human dignity, needs, solidarity and cost-effectiveness. At the other level of prioritisation there are regional projects aiming at the in- and exclusion of medical measures. The Swedish prioritisation process will be described using the example of priority lists in cardiology. (As supplied by publisher). Copyright © 2012. Published by Elsevier GmbH.
Franzén, C; Söderfeldt, B
The manifestly required qualifications in job advertisements in the Journal of the Swedish Dental Association were analyzed as indicators of the organizational ideology in the Swedish Public Dental Health Service from the employers' viewpoint. All job advertisements that concerned dentists and managers on different hierarchical levels in general dentistry from January 1990 to December 1998 were included (n = 1152). The number of vacancies was 1856. The textual material was analyzed by content analysis, permitting quantitative descriptions of the text and analysis of the latent characteristics. Words and phrases were classified into categories on different levels of abstraction developed from the theoretical background and the purpose of the study. Altogether 5705 required qualifications were categorized. The inter-coder reliability of the first-level categorization resulted in 81% correspondence of the classification, and lambda = 0.90. Qualifications were more frequently required with higher hierarchical job positions, and personality characteristics were more frequent than technical competence and knowledge. Qualifications interpreted as related to economic goals occurred more frequently than those related to odontological goals. The qualification demands reflected the language of human resource management (HRM), emphasizing the 'soft' people-centered approach and was interpreted as an 'ideal' model of HRM. Dentists were regarded as a profitable organizational asset rather than participants in relations with patients. In conclusion, the results indicate an organizational ideology primarily of economic character.
Holmberg, Christopher; Caro, Jino; Sobis, Iwona
Swedish mental health-care services are experiencing a critical shortage of nursing personnel. Researchers suggest that this shortage is due to low levels of job satisfaction. Job satisfaction is frequently studied with the assistance of Herzberg's two-factor theory, and this theory has foremost been explored with studies using quantitative methods. The purpose of the present study was to provide a better understanding of Herzberg's theory in relation to job satisfaction among Swedish mental health nursing personnel within inpatient psychiatric care while using qualitative methodology. This explorative study was based on semistructured interviews with 25 nursing personnel. Qualitative content analysis of interview transcripts identified three main categories: (i) respondents' perception of their work duties, which was perceived as important, meaningful, and demanding; (ii) respondents' relations with colleagues and supervisors, which provided valuable support in everyday work; and (iii) the way the respondents experienced their professional role as mental health nurses, which was described as unclear and vague. Job satisfaction primarily stemmed from working for patients and with other professionals, but their perceived limited progression of responsibilities discouraged a career in the profession. Herzberg's theory proved useful in exploring job satisfaction in this setting, but the findings partly contradict the basic tenets of the theory. Career advancements and incentives, such as salary and compensation, were perceived as lacking, which negatively influenced job satisfaction. Ward managers should establish clinical ladder programmes to recognize and motivate the continuing professional development of nurses. This needs to be coupled with monetary incentives, and linked with increased clinical authority. © 2017 Australian College of Mental Health Nurses Inc.
Full Text Available This article studies the process of transformation of the Swedish political party system in the 1980s. The study aims to develop a typology of the Swedish political party system before and after the transformation processes commenced. The article identifies the key prerequisites for such transformation: the crisis of social democracy and an increase in the nationalist attitudes in the society caused by the negative repercussions of the system of integration of migrants into the society based on the multiculturalism principles. The interethnic tension manifested itself in the wide support for the Swedish Democrats Party in the 2010 parliamentary election. From a political party system dominated by social democrats, the Swedish political party system turned into one with two leading parties – the centre-left Swedish Social Democratic Labour Party and the centre-right Moderate Party. The Swedish Democrats position themselves as an alternative to the two party blocs headed by the dominating parties (the Alliance and the Red-Green. The study employs an interdisciplinary approach in the framework of science synthesis. Its results can be of practical significance for politicians, social activists, and academicians.
Borg, Daniel; Lund, Bert-Ove; Lindquist, Nils-Gunnar; Håkansson, Helen
Humans are simultaneously exposed to a multitude of chemicals. Human health risk assessment of chemicals is, however, normally performed on single substances, which may underestimate the total risk, thus bringing a need for reliable methods to assess the risk of combined exposure to multiple chemicals. Per- and polyfluoroalkylated substances (PFASs) is a large group of chemicals that has emerged as global environmental contaminants. In the Swedish population, 17 PFASs have been measured, of which the vast majority lacks human health risk assessment information. The objective of this study was to for the first time perform a cumulative health risk assessment of the 17 PFASs measured in the Swedish population, individually and in combination, using the Hazard Index (HI) approach. Swedish biomonitoring data (blood/serum concentrations of PFASs) were used and two study populations identified: 1) the general population exposed indirectly via the environment and 2) occupationally exposed professional ski waxers. Hazard data used were publicly available toxicity data for hepatotoxicity and reproductive toxicity as well as other more sensitive toxic effects. The results showed that PFASs concentrations were in the low ng/ml serum range in the general population, reaching high ng/ml and low μg/ml serum concentrations in the occupationally exposed. For those congeners lacking toxicity data with regard to hepatotoxicity and reproductive toxicity read-across extrapolations was performed. Other effects at lower dose levels were observed for some well-studied congeners. The risk characterization showed no concern for hepatotoxicity or reproductive toxicity in the general population except in a subpopulation eating PFOS-contaminated fish, illustrating that high local exposure may be of concern. For the occupationally exposed there was concern for hepatotoxicity by PFOA and all congeners in combination as well as for reproductive toxicity by all congeners in combination, thus a
The study investigates the health effects of subjective class position stratified by objective social position. Four types of subjective class were analysed separately for individuals with manual or non-manual occupational background. The cross-sectional analysis is based on the Swedish Level-of-Living Survey from 2000 and includes 4,139…
Hagerhed, L.; Bornehag, Carl-Gustaf; Sundell, Jan
Questionnaire data on 8681 dwellings included in the Swedish study "Dampness in Buildings and Health" have been analysed for associations between dampness indicators, perceptions of indoor air quality and building characteristics such as time of construction, type of ventilation and type...... of foundation. Visible mold or damp stains were reported in 1.3 and 1.6% of single-family and multi-family houses respectively, dampness connected to the floor in 6.5 and 13.9% and condensation on windows in 12.5 and 16.9%. "Stuffy air" was reported in 22.3 and 42.8%, "Moldy odor" in 3.9 and 5.8% and perception...... of "Dry air" in 17.3 and 33.7% respectively. Older buildings and the use of natural ventilation were associated with increased frequency of dampness indicators as well as to increased frequencies of complaints on bad indoor air quality....
Fall, Nils; Emanuelson, Ulf
Organic dairy farming is an expanding segment of the dairy sector where cow management differs from the conventional model in many respects. Thus, a comparative evaluation of disease and welfare status in organically and conventionally managed dairy cows is required. Assessment of milk yield, udder health and reproductive performance (RP) was done in 20 organically and 20 conventionally managed Swedish dairy herds. In accordance with earlier findings we confirmed lower milk yield in organic cows. Udder health and RP were chosen as indicators of animal health in view of their clinical relevance and the availability of appropriate data bases providing good background knowledge for further animal health assessment. No obvious differences were found in the investigations of somatic cell count (SCC) profiles or time to veterinary-treated cases of mastitis between organically and conventional managed cows. Pregnancy success at first insemination, an appropriate measurement of RP with biological interpretation and background, did not reveal any difference between management types, whereas the hazard rate-ratio (HR) of having a calving-interval was significantly lower (HR=0.71) in organically managed cows. The calving-interval is an important financial determinator in dairy production, but it is not considered an optimal indicator of biologic relevance as it partially reflects farmer decisions. In conclusion, the organically managed cows in this study did not differ from conventionally managed cows in udder health or RP, with the exception of calving interval.
Mass media plays a central role in shaping public discourse on health and illness. In order to examine media representations of mental health and expert knowledge in this field, two major Swedish daily newspapers from the year 2009 were qualitatively analysed. Drawing on the theory of social representations, the analysis focused on how issues concerning mental health and different perspectives are represented. The results show how the concept of mental illness is used in different and often taken-for-granted ways and how the distinction between normal and pathological is a central underlying question. Laypersons' perspectives are supplemented by views of professionals in the newspapers, where signs of confidence and dependence on expert knowledge are juxtaposed with critique and expressions of distrust. The newspaper discourse thus has salient argumentative features and the way that conflicts are made explicit and issues concerning authoritative knowledge are addressed indicates ambivalence towards the authoritative role of expert knowledge concerning mental health. In this way, the newspapers provide a complex epistemic context for everyday sense-making that can be assumed to have implications for relations between laypersons and professionals in the field of mental health.
The contemporary global debate about pension reforms is based mainly on the concern for the long-term financial viability of existing government operated ... moved from a defined benefit system to a defined contribution system, Sweden chose a “hybrid”, a model which has received wide acclaim by social security experts.
Eriksson, Andrea; Jansson, Bjarne; Haglund, Bo J A; Axelsson, Runo
The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.
PAYG systems continue to function efficiently and with some parametric reforms, could meet the structural and ..... It refers to changes in the architecture and relationships between the public, agencies and ...... Design of Private Pension Plans: Costs and Benefits of Risk-Sharing",. OECD Working Papers on Insurance and ...
Kostenius, Catrine; Hertting, Krister
The aim of this study was to elucidate Finnish, Norwegian, Russian and Swedish students' reflections and ideas on how interactive technology can be used to promote health in school. The data were collected in the northern part of these four countries, and 630 students aged 13-15 filled out the World Health Organization's 'Health Behavior in School-Aged Children' self-completion questionnaire with one additional open question, which is analyzed in this article (n = 419). The phenomenological analysis resulted in four themes: A sense of control, Balancing enjoyable options, Sharing with others and Learning made easier. The students point out that interactive technology promotes empowerment and independence, reduces stress and makes learning easier. They argue for a healthy balance of Internet use for it to be health promoting. According to the students, good relationships increase well-being; and interactive technology can offer a way to socialize, provide a tool for meeting and making new friends, help when not feeling well and give support when encouraging classmates. We argue, based on the findings of the present study and previous research, that students need a combination of freedom and meaningful relationships with adults who have an empowered child perspective, to fully take advantage of the empowering effects of interactive technology. We suggest, as implications for practice, that teachers, school leaders and health care professionals find ways to act as partners using an appreciative process, asking questions on what works well, to make interactive technology an enabling technology to increase health literacy, thus improving health and well-being in students. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Forssén, Annika S K
This paper explores how a group of elderly women used humour, beauty, and cultural activities to maintain physical and mental well-being. The paper reports on one aspect of a qualitative study on women's work and health in a lifetime perspective. Interviews with 20 strategically selected Swedish women, aged 63 to 83 years, were audiotaped and analysed according to a phenomenological approach. During the interview process, the researchers became increasingly aware that the women had clear ideas about what enabled them to feel well and healthy - even when actually quite diseased. Creating and enjoying humour, beauty, and culture formed part of such strategies. Joking with workmates made hard, low-status jobs easier, helped them endure pain, and helped balance marital difficulties. Creating a nice and comfortable home gave pleasure and a little luxury in a life filled with necessities. Making articles for everyday use more beautiful was regarded as worthwhile, because it gave delight to them and their families. Gains from cultural activities were social, aesthetic, and existential - the latter through a feeling of self-recognition and being heard. Humour, beauty, and culture formed a greater part of these women's survival strategies than expected. Making everyday life more aesthetic is an undervalued aspect of women's health-creating work in the family. Through their lifelong experience as carers and homemakers, elderly women possess special knowledge regarding what may promote health, a knowledge that should be tapped. When supplying elderly women with social care, their needs for humour, beauty, and culture should be respected.
Mahapatra, Krushna; Gustavsson, Leif; Nair, Gireesh (Dept. of Engineering and Sustainable Development, Mid Sweden Univ., Oestersund (Sweden)). e-mail: Krushna.firstname.lastname@example.org
Replacing oil and electric heating systems with innovative heating systems (IHSs) such as bedrock heat pumps, district heating system, and pellet boilers will significantly reduce greenhouse gas emission from Swedish detached houses. However, realizing this potential depends on homeowners' adoption decision, which is influenced by their need, awareness and perception of the advantages associated with the IHSs. In this context, we conducted mail-in questionnaire surveys of 1,500 Swedish homeowners, selected through stratified random sampling method, in Fall 2004, Spring 2007, and Summer 2008. A response rate of 42%, 48% and 37% was obtained in the 2004, 2007 and 2008 surveys, respectively. One of the aims of the series of surveys was to find out if external factors such as provision of investment subsidies and mass media discussion of climate change issues had influenced homeowners awareness and perception of the advantages associated with the IHSs. Results showed that there was no appreciable change in homeowners' perceptions between the years surveyed. They consistently gave higher priority to economic factors over environmental factors in their decision to install a new heating system. Heat pumps were best perceived with respect to the annual energy cost of heating, environmental benignity, increased market value of the house, and low greenhouse gas emissions. Respondents felt that pellet boilers had the lowest investment cost, while district heating system had the perceived advantage of functional reliability.
Lindblom, E.; Arnell, M.; Flores-Alsina, X.
The objective of this paper is to model the dynamics and validate the results of nitrous oxide (N2O)emissions from three Swedish nitrifying/denitrifying, nitritation and anammox systems treating real anaerobic digester sludge liquor. The Activated Sludge Model No. 1 is extended to describe N2O...... production by both heterotrophic and autotrophic denitrification. In addition, mass transfer equations are implemented to characterize the dynamics of N2O in the water and the gas phases.The biochemical model is simulated and validated for two hydraulic patterns: (1) a sequencing batch reactor; and, (2...
Sturesson, Marine; Bylund, Sonya Hörnqvist; Edlund, Curt; Falkdal, Annie Hansen; Bernspång, Birgitta
In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person's employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients' or physicians' gender influences the information in the sickness certificate. An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians' gender were found. Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters. © 2015 the Nordic Societies of Public Health.
Wennström, A; Boman, U Wide; Ahlqwist, M; Björkelund, C; Hakeberg, M
To study perceived mental stress in relation to oral health among Swedish middle-aged women over a 36-year period, including considerations concerning smoking and socioeconomic status (SES). This combined medical and dental study includes three cross-sectional (1968/9 N = 746, 1980/1 N = 432, 2004/5 N = 500) surveys of 38- and 50-year-old women included in the Prospective Population Study of Women in Gothenburg, Sweden. Panoramic radiography was used to register the number of teeth, filled teeth and decayed teeth and the level of periodontal bone loss. The information concerning perceived mental stress, smoking and education (chosen to represent SES) was questionnaire-based. Perceived mental stress increased over the 36-year period, but was not related to oral health. The time of examination year had a protective effect on oral health, with a larger number of remaining teeth, fewer decayed teeth and less periodontal bone loss in the later examination year, 2004/5, compared with 1968/9. Risk factors for poor oral health were smoking, greater age (50 vs. 38 years) and low educational level. Smokers had fewer filled teeth than non-smokers except in 2004/5, and there was a shift over time towards fewer filled teeth among highly educated women. A remarkable increase in perceived mental stress was seen among the women over time, but was not associated with oral health. Smoking, greater age and low educational were risk factors for poor oral health, whereas a later examination year was a protective factor.
Nyberg, Anna; Johansson, Gunn
The aim of this prospective study was to explore predictors of objective career success among Swedish women and men, focussing on gender differences. Data were drawn from the 2008 and 2010 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH) with a total of 3670 female and 2773 male participants. Odds ratios and 95% confidence intervals for job promotion and an above-average salary increase between 2008 and 2010 were obtained through binary logistic regression analyses. Individual and organisational factors measured in 2008 were used as predictors in analyses stratified by sex. Mutual adjustment was performed for these variables, as well as for labour market sector and staff category at baseline. In both sexes, younger age predicted both job promotion and an above-average salary increase. Job promotion was also in both sexes predicted by being part of decision-making processes, having conflicts with superiors, and being eager to advance. Furthermore, promotion was predicted by, among men, being educated to post-graduate level and having an open coping strategy and, among women, working >60 hours/week. An above-average salary increase was predicted in both sexes by having a university education. Postgraduate education, having children living at home, and being very motivated to advance predicted an above-average salary increase among women, as did working 51–60 hours/week and being part of decision-making processes in men. Gender differences were seen in several predictors. In conclusion, the results support previous findings of gender differences in predictors of career success. A high level of education, motivation to advance, and procedural justice appear to be more important predictors of career success among women, while open coping was a more important predictor among men. PMID:26501351
Nyberg, Anna; Magnusson Hanson, Linda L; Leineweber, Constanze; Johansson, Gunn
The aim of this prospective study was to explore predictors of objective career success among Swedish women and men, focussing on gender differences. Data were drawn from the 2008 and 2010 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH) with a total of 3670 female and 2773 male participants. Odds ratios and 95% confidence intervals for job promotion and an above-average salary increase between 2008 and 2010 were obtained through binary logistic regression analyses. Individual and organisational factors measured in 2008 were used as predictors in analyses stratified by sex. Mutual adjustment was performed for these variables, as well as for labour market sector and staff category at baseline. In both sexes, younger age predicted both job promotion and an above-average salary increase. Job promotion was also in both sexes predicted by being part of decision-making processes, having conflicts with superiors, and being eager to advance. Furthermore, promotion was predicted by, among men, being educated to post-graduate level and having an open coping strategy and, among women, working >60 hours/week. An above-average salary increase was predicted in both sexes by having a university education. Postgraduate education, having children living at home, and being very motivated to advance predicted an above-average salary increase among women, as did working 51-60 hours/week and being part of decision-making processes in men. Gender differences were seen in several predictors. In conclusion, the results support previous findings of gender differences in predictors of career success. A high level of education, motivation to advance, and procedural justice appear to be more important predictors of career success among women, while open coping was a more important predictor among men.
Full Text Available The aim of this prospective study was to explore predictors of objective career success among Swedish women and men, focussing on gender differences. Data were drawn from the 2008 and 2010 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH with a total of 3670 female and 2773 male participants. Odds ratios and 95% confidence intervals for job promotion and an above-average salary increase between 2008 and 2010 were obtained through binary logistic regression analyses. Individual and organisational factors measured in 2008 were used as predictors in analyses stratified by sex. Mutual adjustment was performed for these variables, as well as for labour market sector and staff category at baseline. In both sexes, younger age predicted both job promotion and an above-average salary increase. Job promotion was also in both sexes predicted by being part of decision-making processes, having conflicts with superiors, and being eager to advance. Furthermore, promotion was predicted by, among men, being educated to post-graduate level and having an open coping strategy and, among women, working >60 hours/week. An above-average salary increase was predicted in both sexes by having a university education. Postgraduate education, having children living at home, and being very motivated to advance predicted an above-average salary increase among women, as did working 51-60 hours/week and being part of decision-making processes in men. Gender differences were seen in several predictors. In conclusion, the results support previous findings of gender differences in predictors of career success. A high level of education, motivation to advance, and procedural justice appear to be more important predictors of career success among women, while open coping was a more important predictor among men.
Hasselkvist, Agneta; Johansson, Anders; Johansson, Ann-Katrin
The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents. A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13-14 years, n = 195; 18-19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression. Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18-19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer. High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.
Full Text Available Abstract Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1 an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2 an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3 an increased use of motivational interviewing (MI and separate ‘fathers visits’ in child health care 4 improvements in the supply of healthy snacks and beverages in open pre-schools and 5 increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector
Ståhl, Christian; Toomingas, Allan; Aborg, Carl; Ekberg, Kerstin; Kjellberg, Katarina
In 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived. The study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions. The subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy--for coordinated interventions--was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed. The study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law.
The main aim of the Swedish Women's Peace reform in 1998 was to enhance criminal legal protection for women exposed to violence in heterosexual relationships and to promote gender equality. However, these ambitions risk being contravened in a masculinist criminal legal system. One problem concerns how the victim is constructed in criminal legal cases. The author argues that moral balancing and discourses of responsibility and guilt in Swedish cases constrain the agency possible for women and suggest that a more comprehensive policy in Sweden must be developed to include violent men, their agency, and their responsibility for the violence.
Isma, Gabriella E; Bramhagen, Ann-Cathrine; Ahlstrom, Gerd; Ostman, Margareta; Dykes, Anna-Karin
Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect
Rosenberg, David; Schön, Ulla-Karin; Nyholm, Maria; Grim, Katarina; Svedberg, Petra
Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.
Vanamölder, Kaarel, 1981-
Arvustus: Connecting the Baltic area : the Swedish postal System in the seventeenth century. Ed. by Heiko Droste. Södertörn Studies in History, 9, Södertörn Academic Studies, 42 (Huddinge: Södertörns högskola, 2011)
Roos, Susanne; Wilhelmsson, Susan; Hallert, Claes
To examine whether the perceived poor outcome of dietary treatment makes Swedish women with coeliac disease (CD) prone to use more health care services than other women. The health care consumption over 36 consecutive months was examined for 137 Swedish women aged 20-80 years with CD in remission after living on a gluten-free diet for a median of 4 years (range 1-8 years). Comparisons were made with the health care consumption of 411 women in the general population matched for age and residence. The results show that women with CD use health care services annually a median of 5.0 times (range 0-76) that is more than female controls 3.6 (0-311) (p Women with CD used health care services in keeping with studies indicating reduced health-related quality of life of people with this condition. The results provide evidence that women with CD in remission suffer from co-morbidities that may signal a need for a multidisciplinary follow-up of subjects with CD in Sweden.
Olesen, Charlotte; Sørensen, Henrik Toft; Berg, Lolkje de Jong-van den
-classifiable drugs accounted for 40.9%, 26.6% and 28.7% respectively. The proportion of women who redeemed drugs was 29.2%, 8.6%, 18.7% and 0.9% from drug groups A, B, C and D respectively. The proportion of prescriptions from high risk groups declined during the course of pregnancy. Postpartum, safe drugs (group I......AIM: To assess the current prescribing pattern for 15,756 primiparae before, during, and after their pregnancies with reference to fetal and neonatal risk. METHOD: A prescription database study with linkage to The Danish Medical Birth Registry from 1991 to 1996. The drug subsidy system in Danish...... retail pharmacies, made it possible to identify prescriptions by individual use. All 34,334 prescriptions were set against the Swedish classification of risk of drug use in pregnancy and lactation. RESULTS: During pregnancy, safe (group A), potentially harmful (group B3, C, and D), and non...
Fritzell, Anni (Dept. of Physics and Astronomy, Uppsala Univ., Uppsala (Sweden))
This thesis has investigated system aspects of safeguarding the back-end of the Swedish nuclear fuel cycle. These aspects include the important notion of continuity of knowledge, the philosophy of verifying measurements and the need to consider the safeguards system as a whole when expanding it to include the encapsulation facility and the geological repository. The research has been analytical in method both in the identification of concrete challenges for the safeguards community in Paper 1, and in the diversion path analysis performed in Paper 2. This method of work is beneficial for example when abstract notions are treated. However, as a suggestion for further work along these lines, a formal systems analysis would be advantageous, and may even reveal properties of the safeguards system that the human mind so far has been to narrow to consider. A systems analysis could be used to model a proposed safeguards approach with the purpose of finding vulnerabilities in its detection probabilities. From the results, capabilities needed to overcome these vulnerabilities could be deduced, thereby formulating formal boundary conditions. These could include: The necessary partial defect level for the NDA measurement; The level of redundancy required in the C/S system to minimize the risk of inconclusive results due to equipment failure; and, Requirements on the capabilities of seismic methods, etc. The field of vulnerability assessment as a tool for systems analysis should be of interest for the safeguards community, as a formal approach could give a new dimension to the credibility of safeguards systems
Berntsson, Leeni T; Ringsberg, Karin C
Nordic children's health has declined. Studies show that parents' engagement in children's leisure-time activities might provide beneficial health outcomes for children. The aim of the present study was to examine the association between Swedish parents' activities together with their children, the parents' experiences of time pressure and their children's health. Data of 1461 Swedish children aged 2-17 years old that were collected in the NordChild study of 2011 were used. We analyzed physical health, diseases and disabilities, psychosomatic health and well-being, and the parents' experiences of time pressure; and we calculated the associations between parental activity together with the child and health indicators. Activities that were significantly and positively associated with children's health at ages 2-17 years of age were: playing and playing games; going to the cinema, theatre, and sporting events; reading books; playing musical instruments/singing; sports activities; watching TV/video/DVD. Playing video games or computer games, driving child to activities and going for walks were significantly and positively associated at age groups 7-12 years and 13-17 years. Activities that were negatively associated with health were: surfing/blogging on the Internet, going shopping and doing homework. Parents who were not experiencing time pressures had a higher level of activity together with their children. The parental experience of time pressure was associated with work time, with less homework activity and more symptoms in children. The family and home are important settings for the development of children's health we found eight parental activities together with their children that promoted the children's health parents' working time and their time pressure experiences affected their activities with their children there is a need for an increased focus on parental activities that are positively associated with children's health. © 2014 the Nordic Societies of
Full Text Available Objectives. To investigate the health of young Sami in Sweden and the relationship between health and experience of negative societal treatment due to ethnicity, as well as socio-demographic background factors. Study design. Cross-sectional population-based questionnaire study. Methods. A total of 876 persons aged 18–28 and involved in Sami associated activities were addressed, and 516 (59% responded to a questionnaire investigating physical health, mental health, and stress. Data were analyzed with regard to gender, family situation, occupation, education, enculturation factors and experience of being badly treated because of ethnicity. Results. A majority of the young Sami reported feeling healthy, but close to half of the group reported often having worries, often forgetting things and often experiencing lack of time for doing needed things. Women and those living alone reported a more negative health. Furthermore, half of the group had perceived bad treatment because of Sami ethnicity, and this was negatively associated with some aspects of mental health. Conclusion. The young Sami had a rather good and possibly slightly better health than other young Swedes, except regarding worries and stress. A high degree of bad treatment due to Sami ethnicity and its negative association with health, may partly explain the high degree of some health problems.
Wangel, Anne-Marie; Schei, Berit; Ryding, Elsa Lena
the past week and PTS symptoms during the past year. RESULTS: Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social...
Cederlund, Torsten; Finck, Robert; Mjoenes, Lars; Moberg, Leif; Soederman, Ann-Louis; Wiklund, Aasa; Yuen Katarina; Oelander Guer, Hanna
The Swedish Government has requested the Swedish Radiation Protection Authority (SSI) to make an account of the authority's role in the field of public health. Radiation Protection consists largely of preventive actions in order to protect man and the environment against harmful effects of radiation. The SSI thus considers most of the authority's activities to be public health related. The report describes a number of radiation protection areas from a health perspective. The measures taken by the authority in these areas are also described along with planned activities. In some areas the authority also points out additional measures.
Hyrke, Lena; Almen, Anja; Blixt, Anders; Brewitz, Erica; Mjoenes, Lars; Moberg, Leif; Skeppstroem, Kirlna; Wester, Ulf
The Swedish Government has requested that the Swedish Radiation Protection Authority (SSI) to make an account of the authority's role in the field of public health. Radiation Protection consists largely of preventive actions in order to protect man and the environment against harmful effects of radiation. The SSI thus considers most of the authority's activities to be public health related. The report describes a number of radiation protection areas from a health perspective. The measures taken by the authority in these areas are also described along with planned activities. In some areas the authority also points out additional measures
Full Text Available This paper deals with translating legal terminology concerning child maintenance from Polish to Swedish. The analysis covers selected terms regulated in the Polish civil law and their possible Swedish equivalents. The method used is based on the parameterisation of legal terms, which allows the specification of terms by selected parameters, which are understood as mutually exclusive properties. The parameterised equivalents are analysed in the context of various types of recipients. This provides the basis for the choice of appropriate translation strategies. The author also discusses pragmatic equivalents featured in Rikstermbanken, the Swedish national terminological database, and those used in practice.
Full Text Available BACKGROUND: Earlier studies have suggested that sickness presenteeism (SP may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers. METHODS: Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR with 95% confidence intervals (CI were calculated using logistic regression. RESULTS: Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12, also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06. Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health. CONCLUSION: The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.
Taloyan, Marina; Aronsson, Gunnar; Leineweber, Constanze; Magnusson Hanson, Linda; Alexanderson, Kristina; Westerlund, Hugo
Background Earlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers. Methods Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression. Results Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98–7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30–2.06). Those who reported 1–7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health. Conclusion The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health. PMID:22984547
Söderström, Staffan; Pettersson, Richard; Edlund-Söderström, Kerstin; Ganse, Gunnar; Holmkvist, Eva; Westin, Olof; Haglund, Lena
Attention-deficit hyperactivity disorder (ADHD) in adults is a phenomenon that attracts a lot of attention in society today. Advances in research have made it clear that many conditions that make people seek medical and psychiatric care may have pervasive deficits in attention, motor control and impulsivity at their roots. Since ADHD in adults is a relatively new and very versatile concept, there is a great need for systemized classification of the ramifications of the deficit that extends into every aspect of these patients' lives. To develop a Swedish Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for adult patients with ADHD. A national expert survey was conducted using the Delphi technique and a formal consensus conference. Forty-two experts from different professions and organizations, including psychiatrists and physicians, psychologists, occupational therapists, a counsellor, a specialist nurse, representatives from a patient organization and representatives from the Swedish Social Insurance Agency, participated in the Delphi process and 28 participants from the expert group attended the consensus conference. At the formal consensus conference, 66 categories from the ICF were identified and included in the national Comprehensive Core Set for ADHD: 21 categories from the component body functions, 26 categories from the component activities and participation, and 19 categories from the component environmental factors. The Comprehensive Core Set for ADHD should be regarded as national and preliminary, and should be further tested and evaluated by experts in ADHD in clinical settings in Sweden.
Mahapatra, K.; Gustavsson, L. [Ecotechnology, Mid Sweden University, 831 25 Oestersund (Sweden)
Questionnaire surveys of Swedish homeowners of detached houses were carried out in 2004 and 2007 to understand their needs and attitudes towards attributes of innovative heating systems (IHSs) comprised of a bedrock heat pump, district heating, or a wood pellet boiler. In each occasion 1,500 homeowners were randomly selected. The response rate was 42% in 2004 and 48% in 2007. Results showed that the majority of the respondents were satisfied with their existing heating system and did not intend to install new systems. Economic factors and functional reliability were the most important factors in the respondents' choices of heating system, while environmental factors were of lower importance. Among the IHSs, respondents had the most favorable attitude towards bedrock heat pumps followed by district heating and pellet boilers. But the attitude was more favorable towards electric boilers than for pellet boilers. The least favorable attitude was towards oil boilers. Between 2004 and 2007, there was a positive change in respondents' attitude towards IHSs and electric boilers, and a negative change in attitude towards resistance heaters and oil boilers.
Vinberg, Stig; Romild, Ulla; Landstad, Bodil J
Leaders and co-workers in Swedish public sector organizations are exposed to demanding psychosocial working conditions; more knowledge about workplace-based interventions in this sector of working life is needed. To compare co-workers' and leaders' self-ratings of health and psychosocial working conditions, and investigate how prevention and rehabilitation in Swedish public sector workplaces affects these ratings. The longitudinal panel data consisted of 311 individuals (20 leaders, 291 co-workers) at 19 workplaces. Based on questionnaire data, statistical analyses were performed using Mann-Whitney U-Test, pair-wise Spearman correlations, a mixed between-within subjects ANOVA and Friedman's test. Results indicate differences in how the leaders and the co-workers judge their health and psychosocial working conditions. Leaders report work content that is more varied and interesting as well as more possibilities for personal development through work, yet they also report more tiredness, concern over managing their work situation and time pressure at work. Comparisons of mean values for used indicators show some improvements after one year, but also several non-significant or negative time trends two years after the interventions were initiated. The study provides some support for experienced differences between co-workers' and leaders' health and psychosocial working conditions in public sector workplaces, indicating the importance of different workplace-oriented prevention and rehabilitation interventions for these two categories of employees.
Guldbrandsson, Karin; Fossum, Bjöörn
In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three 'streams', the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts 'policy windows' and 'policy entrepreneurs' could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers' ability to detect actors possessing policy entrepreneur resources.
Waste incineration within the Swedish district heating systems - Sub-Project 4; Avfallsfoerbraenning inom Sveriges fjaerrvaermesystem - Delprojekt 4 inom projektet Perspektiv paa framtida avfallsbehandling
Haraldsson, Maarten; Holmstroem; David
Waste incineration within the Swedish district heating systems is one of the five sub-projects within the project Perspectives on sustainable waste treatment. The goal of this project is to evaluate the economic potential for waste incineration in the Swedish district heating systems. With the current expansion of incineration, we may relatively soon reach an upper limit for what is demanded by the Swedish district heating systems. How much more waste incineration that is economically attractive to build is of great importance for the development of the Swedish waste system, not least for the alternatives to incineration as for example biogas production. With continued rising quantities of waste and stagnant demand for waste incineration from the district heating systems, today's surplus of treatment capacity may change the market picture for other waste treatment options. How much more waste incineration requested and how quickly the market reaches this level is studied in this project.
Full Text Available The article explores the major features of the Swedish Government’s new initiative - a school based Upper Secondary Apprenticeship model. The analyses are guided by activity theory. The analysed texts are part of the parliamentary reformmaking process of the 2011 Upper Secondary School reform. The analyses unfold how the Government, the Swedish Trade Union Confederation (LO, and the Confederation of Swedish Enterprise (SN construct Upper Secondary Apprenticeship as an activity in the 21st century. The conclusion highlights how three traditional aspects of Swedish initial vocational education and training (IVET collide in the formation of Upper Secondary Apprenticeship – a curriculum of labour market based apprenticeships, a curriculum of school based IVET, and ill-defined curriculums of school based apprenticeships. The emerging Upper Secondary Apprenticeship curriculum foreshadows multifaceted educational trajectories where the learning targets, and not the responsibility for the student’s learning are displaced from the school to the workplace setting.
Nilsson Gunnar H
Full Text Available Abstract Background Terminologies and classifications are used for different purposes and have different structures and content. Linking or mapping terminologies and classifications has been pointed out as a possible way to achieve various aims as well as to attain additional advantages in describing and documenting health care data. The objectives of this study were: • to explore and develop rules to be used in a mapping process • to evaluate intercoder reliability and the assessed degree of concordance when the 'Swedish primary health care version of the International Classification of Diseases version 10' (ICD-10 is matched to the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT • to describe characteristics in the coding systems that are related to obstacles to high quality mapping. Methods Mapping (interpretation, matching, assessment and rule development was done by two coders. The Swedish primary health care version of ICD-10 with 972 codes was randomly divided into an allotment of three sets of categories, used in three mapping sequences, A, B and C. Mapping was done independently by the coders and new rules were developed between the sequences. Intercoder reliability was measured by comparing the results after each set. The extent of matching was assessed as either 'partly' or 'completely concordant' Results General principles for mapping were outlined before the first sequence, A. New mapping rules had significant impact on the results between sequences A - B (p Conclusion Mapping from ICD-10-categories to SNOMED CT needs clear and extensive rules. It is possible to reach high intercoder reliability in mapping from ICD-10-categories to SNOMED CT. However, several obstacles to high quality mapping remain due to structure and content characteristics in both coding systems.
Novak, M; Ahlgren, C; Hammarstrom, A
To explore the pattern and determinants of inter- and intragenerational occupational mobility among Swedish men and women. A Swedish 14-year prospective longitudinal study (response rate 96.5%). Detailed information on 546 men and 495 women regarding their occupation, health status, health-related behaviour, psychosocial environment at home and school, material recourses and ethnicity prior to mobility were available at 16, 21 and 30 years of age. Odds ratios and 99% confidence intervals were calculated using logistic regression to determine social mobility. The results indicated that being popular at school predicted upward mobility, and being less popular at school predicted downward mobility. Additionally, material deprivation, economic deprivation, shorter height (women) and poor health behavioural factors predicted downward mobility. Among this cohort, being less popular at school was more common among subjects whose parents had low socio-economic status. Occupational mobility was not influenced by ethnic background. Apart from height (women), health status was not associated with mobility for men or women either inter- or intragenerationally. Unfavourable school environment was a consistent predictor of mobility for both genders. The results indicate that schools should be used as a setting for interventions aimed at reducing socio-economic health inequities. Targeted school interventions that are designed to assist higher educational attainment of socio-economically disadvantaged youth would help to break the social chain of risk experienced during this time, and thereby alter their life course in ways that would reduce subsequent social inequities in health and well-being. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin
Although there has been an emphasis on developing knowledge regarding recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Instruments, which present the components of recovery as measurable dimensions of change, may provide a framework for program development. Involving users is an essential factor in the utilization of such tools. The purpose of this study was to evaluate the psychometric properties of the Recovery Self-Assessment (RSA) measure and its potential for being utilized in a Swedish context. The sample consisted of 78 participants from 6 community mental health services targeting people with serious mental illnesses in a municipality in Sweden. They completed the RSA at the study baseline and two weeks later. User panels participated in the translation and administration of the RSA and the reporting of results. The Swedish version of the RSA had good face and content validity, satisfactory internal consistency, and a moderate to good level of stability in test-retest reliability. The user panels contributed to establishing validity and as collaborators in the study. Establishing the RSA as a valid and reliable instrument with which to focus on the recovery orientation of services is a first step in beginning to study the types of interventions that may effect and contribute to recovery oriented practice in Sweden. (c) 2015 APA, all rights reserved).
Garemo, Malin; Arvidsson Lenner, Ragnhild; Nilsson, Ellen Karlge; Borres, Magnus P; Strandvik, Birgitta
Dietary habits founded early in life might influence development of welfare diseases. The aim was to analyse food choice, socio-economic characteristics and health by questionnaires in healthy 4-year olds. Two hundred and thirty children were invited and 79% completed all questionnaires. Anthropometry was measured in 131 subjects. The sample was characteristic for Swedish children except that more parents had university education. Most children attended pre-school; 52% >30 h/week. Almost all had been breast-fed until a mean age of 5 months. Fifteen per cent were overweight and 2% obese according to the IOTF cut-offs. A, D vitamin supplementation was not given to a third. Full fat dairy products, minced meat and sausages predominated, and only a fourth was served fat fish. Olive or rape seed oil was consumed regularly by 40% and a third consumed "junk food" regularly. Maternal immigrant status influenced the food choice. In a Swedish urban community of 4-year olds, 17% were overweight or obese. The intake of vegetables, oils and "junk food" seemed to have increased, while the intake of dairy products, fruit, meat and fish seemed to be similar to earlier studies. Food choice was influenced by maternal origin.
According to United Nations' esti- mates, in 2010, some 800 women died every day from complications of pregnancy or childbirth, 99% of them in developing countries. Some 7.6 mil- lion children died before the age of five. While these numbers are high, they do reflect considerable gains for maternal and child health since ...
Charisse M. Johnson
Full Text Available Abstract Background Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden’s population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1 if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2 if mental health status converges with that of Swedish-born with longer duration of residence; and 3 if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born. Methods This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test. Results The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden
Johnson, Charisse M; Rostila, Mikael; Svensson, Anna C; Engström, Karin
Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born. This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test. The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or
Forslin, Mia; Kottorp, Anders; Kierkegaard, Marie; Johansson, Sverker
To translate and culturally adapt the Acceptance of Chronic Health Conditions (ACHC) Scale for people with multiple sclerosis into Swedish, and to analyse the psychometric properties of the Swedish version. Ten people with multiple sclerosis participated in translation and cultural adaptation of the ACHC Scale; 148 people with multiple sclerosis were included in evaluation of the psychometric properties of the scale. Translation and cultural adaptation were carried out through translation and back-translation, by expert committee evaluation and pre-test with cognitive interviews in people with multiple sclerosis. The psychometric properties of the Swedish version were evaluated using Rasch analysis. The Swedish version of the ACHC Scale was an acceptable equivalent to the original version. Seven of the original 10 items fitted the Rasch model and demonstrated ability to separate between groups. A 5-item version, including 2 items and 3 super-items, demonstrated better psychometric properties, but lower ability to separate between groups. The Swedish version of the ACHC Scale with the original 10 items did not fit the Rasch model. Two solutions, either with 7 items (ACHC-7) or with 2 items and 3 super-items (ACHC-5), demonstrated acceptable psychometric properties. Use of the ACHC-5 Scale with super-items is recommended, since this solution adjusts for local dependency among items.
Drakenberg, Margareth; Malmgren, Therese Vincenti
The purpose of this study is to compare how Swedish school principals understand basic values that are important in fulfilling the Swedish national curriculum, Curriculum 1994 (a new curriculum, Curriculum 2011, which came into operation in autumn 2011, has only minor differences compared to the common text in Curriculum 1994), considering…
Sweden has a long tradition of social democracy and corporate cooperation. Social problems are treated as technological questions that always should be solved through rational and neutral means. Today Sweden faces a crisis of economy as well as a crisis of medicine. In the spirit of consensus, the state has proposed a new health reform emphasizing the responsibility of the public health service to prevent disease and provide equal access to care. It is claimed that improved health planning, based on epidemiological knowledge on inequalities, can solve the crisis in medicine within an improved system of primary care and prevention. However, in the context of the current economic crisis, the struggle against health hazards and cuts in public spending has intensified and the gap between the ideology of technological rationalism and reality has widened.
Wandin, Helena; Lindberg, Per; Sonnander, Karin
To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome. A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services. The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person. Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].
This study explores the educational potential of a place-responsive pedagogy to teaching and learning in "friluftsliv" within the Swedish physical education and health (PEH) curriculum. The study draws on qualitative empirical materials from a yearlong research project, together with a group of high school PEH teachers working in seventh…
Background: Physical Education (PE) has been associated with a multi-activity model in which movement is related to sport discourses and sport techniques. However, as in many international contexts, the Swedish national PE syllabus calls for a wider and more inclusive concept of movement. Complex movement adapted to different settings is valued,…
Jansson Elisabeth VG
Full Text Available Abstract Background Several health determinants are related to local conditions and prerequisites at community level. For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. Such action includes setting priorities, making decisions, planning strategies, and implementing them to achieve better health. The aim of this paper is to obtain a deeper understanding of content, organization and processes in the development of local health promotion. Methods A qualitative multiple case study of four Swedish municipalities. The cases were analyzed in accordance with the principles of cross-case study analysis, and a content analysis of documents and interviews was conducted in two steps. First, a manifest content analysis was performed to identify present and former actors and measures. Thereafter, a latent content analysis was performed to investigate structures and processes in local contexts. Results The results of the inductive content analysis showed development of local health promotion in three phases: initiation, action, and achievement. Strengthening factors were local actors, health statistics and events. Hindering factors were lack of resources and vague objectives. External factors, e.g. national policies, were not perceived as prominent influencing factors. Media reports were regarded as having had an influence, but only to some extent. The content of local health promotion has developed from ad-hoc lifestyle and behaviour-related actions into structural, intersectoral actions related to determinants of health. Conclusions The municipalities have organized and developed their health promotion targets, actions and priorities on the basis of local needs and prerequisites. The three phases in the identified health promotion processes were experienced and documented as being subject to greater influence from internal rather than external strengthening and hindering
Skoog, Malin; Hallström, Inger; Berggren, Vanja
Due to the current world situation, Sweden has one of the highest asylum applications within the European Union. Immigrant mothers, specifically those who have immigrated during the last ten years and do not speak the language of the new country, are found to be at particular risk of being effected by postpartum depression. In this study, we elucidate Swedish Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers. Latent content analysis was used when analysing data material from 13 research interviews. Being able to interpret a non-Swedish-speaking immigrant mother's mood required establishing and constant deepening of a transcultural caring relationship, the use of cultural knowledge to perceive signs of postpartum depression from observations and interactions and to rely on intuition. There are both challenges and key factors for success in interpreting the mood of non-Swedish-speaking immigrant mothers. This study provides information to healthcare professionals about challenges with adapting the screening with the Edinburgh Postnatal Depression Scale to immigrant mothers not speaking the language of residence. Tacit knowledge and cultural competence among healthcare personnel are invaluable assets when interpreting mental health in this vulnerable group of mothers. © 2017 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.
Salo, Ilkka (Risk Analysis, Social and Decision Research Unit, Dept. of Psychology, Stockholm Univ., Stockholm (Sweden))
The present study investigated safety management characteristics reflected in interviews with participants from two Swedish nuclear power plants. A document analysis regarding the plants' organization, safety policies, and safety culture work was carried out as well. The participants (n=9) were all nuclear power professionals, and the majority managers at different levels with at least 10 years of nuclear power experience. The interview comprised themes relevant for organizational safety and safety management, such as: organizational structures and organizational change, threats to safety, information feedback and knowledge transfer, safety analysis, safety policy, and accident and incident analysis and reporting. The results were in part modeled to important themes derived from a general system theoretical framework suggested by Svenson and developed by Svenson and Salo in relation to studies of 'non-nuclear' safety organizations. A primer to important features of the system theoretical framework is presented in the introductory chapter. The results from the interviews generated interesting descriptions about nuclear safety management in relation to the above themes. Regarding organizational restructuring, mainly centralizations of resources, several examples of reasons for the restructuring and related benefits for this centralization of resources were identified. A number of important reminders that ought to be considered in relation to reorganization were also identified. Regarding threats to the own organization a number of such was interpreted from the interviews. Among them are risks related to generation and competence change-over and risks related to outsourcing of activities. A thorough picture of information management and practical implications related to this was revealed in the interviews. Related to information feedback is the issue of organizational safety indicators and safety indicators in general. The interview answers indicated
Full Text Available This study addressed school-contextual features of social disorder in relation to sixth-grade students’ experiences of bullying victimization and mental health complaints. It investigated, firstly, whether the school’s concentrations of behavioural problems were associated with individual students’ likelihood of being bullied, and secondly, whether the school’s concentrations of behavioural problems and bullying victimization predicted students’ emotional and psychosomatic health complaints. The data were derived from the Swedish National Survey of Mental Health among Children and Young People, carried out among sixth-grade students (approximately 12–13 years old in Sweden in 2009. The analyses were based on information from 59,510 students distributed across 1999 schools. The statistical method used was multilevel modelling. While students’ own behavioural problems were associated with an elevated risk of being bullied, attending a school with a higher concentration of students with behavioural problems also increased the likelihood of being bullied. Attending a school with higher levels of bullying victimization and behavioural problems predicted more emotional and psychosomatic complaints, even when adjusting for their individual level analogues. The findings indicate that school-level features of social disorder influence bullying victimization and mental health complaints among students.
Elisabeth S. Lindholm
Full Text Available Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI. Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, n=71,638. Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (p<0.001, had longer antenatal hospital stays (p<0.001, and were more often sick-listed by an obstetrician (p<0.001 during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women (p<0.001 for all comparisons. Underweight mothers had longer stay in hospitals (p<0.05 and hydronephrosis and hyperemesis gravidarum were more than twice as common (both p<0.001. Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight.
Wettergren, Björn; Blennow, Margareta; Hjern, Anders; Söder, Olle; Ludvigsson, Jonas F
On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background In March 2007, the Norwegian Institute of Public Health was notified of Swedish individuals diagnosed with cryptosporidiosis after staying at a Norwegian hotel. In Norway, cryptosporidiosis is not reportable, and human infections are rarely diagnosed. Methods A questionnaire on illness and exposure history was e-mailed to seven organised groups who had visited the hotel in March. Cases were defined as persons with diarrhoea for more than two days or laboratory-confirmed cryptosporidiosis during or within two weeks of the hotel visit. The risk factor analysis was restricted to two groups with the highest attack rates (AR and same hotel stay period. Local food safety authorities conducted environmental investigations. Results In total, 25 diarrhoeal cases (10 laboratory-confirmed were identified among 89 respondents. Although environmental samples were negative, epidemiological data suggest an association with in-house water consumption. In one group, the AR was higher amongst consumers of water from hotel dispenser (relative risk [RR] = 3.0; 95% confidence interval [CI]: 0.9–9.8, tap water (RR = 2.3; CI: 0.9–5.8, and lower amongst commercial bottled water drinkers (RR = 0.6; CI: 0.4–1.0. Consumption of ice cubes was a risk-factor (RR = 7.1; CI: 1.1–45.7 in the two groups combined. Conclusion This outbreak would probably have remained undetected without the alert from Swedish health authorities, illustrating the difficulties in outbreak detection due to low health care seeking behaviour for diarrhoea and limited parasite diagnostics in Norway. Awareness of cryptosporidiosis should be raised amongst Norwegian medical personnel to improve case and outbreak detection, and possible risks related to in-house water systems should be assessed.
Hajdu, Agnes; Vold, Line; Østmo, Torild A; Helleve, Anna; Helgebostad, Sigrid R; Krogh, Truls; Robertson, Lucy; de Jong, Birgitta; Nygård, Karin
In March 2007, the Norwegian Institute of Public Health was notified of Swedish individuals diagnosed with cryptosporidiosis after staying at a Norwegian hotel. In Norway, cryptosporidiosis is not reportable, and human infections are rarely diagnosed. A questionnaire on illness and exposure history was e-mailed to seven organised groups who had visited the hotel in March. Cases were defined as persons with diarrhoea for more than two days or laboratory-confirmed cryptosporidiosis during or within two weeks of the hotel visit. The risk factor analysis was restricted to two groups with the highest attack rates (AR) and same hotel stay period. Local food safety authorities conducted environmental investigations. In total, 25 diarrhoeal cases (10 laboratory-confirmed) were identified among 89 respondents. Although environmental samples were negative, epidemiological data suggest an association with in-house water consumption. In one group, the AR was higher amongst consumers of water from hotel dispenser (relative risk [RR] = 3.0; 95% confidence interval [CI]: 0.9-9.8), tap water (RR = 2.3; CI: 0.9-5.8), and lower amongst commercial bottled water drinkers (RR = 0.6; CI: 0.4-1.0). Consumption of ice cubes was a risk-factor (RR = 7.1; CI: 1.1-45.7) in the two groups combined. This outbreak would probably have remained undetected without the alert from Swedish health authorities, illustrating the difficulties in outbreak detection due to low health care seeking behaviour for diarrhoea and limited parasite diagnostics in Norway. Awareness of cryptosporidiosis should be raised amongst Norwegian medical personnel to improve case and outbreak detection, and possible risks related to in-house water systems should be assessed.
Ullemar, Vilhelmina; Lundholm, Cecilia; Örtqvist, Anne K; Gumpert, Clara Hellner; Anckarsäter, Henrik; Lundström, Sebastian; Almqvist, Catarina
Non-random selection into a study population due to differences between consenters and non-consenters may introduce participation bias. Past investigations of factors predicting consent to collection of medical health records for research imply that age, sex, health status, and education are of importance for participation, but disagree on the direction of effects. Very little is known about influences on consent from adolescents. Two cohorts of Swedish 15-year-old twins (total n = 4,611) previously invited to the Child and Adolescent Twin Study in Sweden (CATSS) responded to a questionnaire with information on sex, individual's health, height, weight, and parental factors. The questionnaire included a question for consent to collection of medical health records. Predictors for consent were analyzed using logistic regression. Additionally, regional differences in the collection of health records of consenters were evaluated. Males were significantly less likely to consent compared to females (OR 0.74, 95% CI 0.64-0.85). The twin siblings' decision to consent was strongly associated with consent (OR 10.9, 95% CI 8.76-13.5), and individuals whose parents had responded to the original CATSS study were more likely to consent to record collection at age 15 (OR 2.2, 95% CI 1.81-2.75). Results of the subsequent collection of consenters' medical health records varied between geographical regions of Sweden. We identified several predictors for adolescents' consent to collection of their medical health records. Further selection was introduced through the subsequent record collection. Whether this will induce participation bias in future studies depends on the research questions' relationship to the identified predictors.
Carlsund, Asa; Eriksson, Ulrika; Sellström, Eva
In Sweden, shared physical custody following a parental separation has emerged as means for children to keep close relationships with both parents. Previous studies show that children benefit from regular contact with both parents, who share responsibility for their social, emotional and economic welfare. In this study, we investigate any associations between family arrangements, that is, two-parent, single and shared physical custody families and child health outcomes and whether this association was modified by parent-child communication. Data on 11- to 15-year-old children from the 2005/2006 and 2009/2010 Swedish Health Behaviour in School-aged Children survey were analysed using multivariate logistic regression. Children in shared physical custody were more likely than children in two-parent families to report multiple health complaints (OR 1.26) and low well-being (OR 1.71). When variables of parent-child communication were entered in the model, the initial differences remained between children living in shared physical custody and those living in two-parent families. Children in shared physical custody and single-parent families are more at risk of negative outcomes compared with children in two-parent families. This association was not modified by parent-child communication in children in shared custody families, indicating that the communication equals that in two-parent family children. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.
Bodil J. Landstad
Full Text Available Municipal workplaces have high levels of sickness absence, and deterioration of the psychosocial work environment has been most pronounced for women and employees in this sector of Swedish working life. This study explores how female leaders in one rural municipality in Sweden experience their psychosocial working conditions and its health consequences. Interviews were carried out with 20 female leaders. Data were analyzed with a content analysis method using major dimensions of work stress models. These were job demands, job control, job resources, social support, and its health consequences. The analysis shows that the leaders experience high and conflicting job demands, limited possibilities to influence their work situation, insufficient job resources and social support, and limited time for their own health promotion. However, the leaders experience possibilities to develop skills in their jobs and opportunities to participate in educational programs. The analyses confirm the need for improvements in the prerequisites for female leaders in public human service organizations. It is important to improve female leaders’ psychosocial working conditions by implementing a more narrow control range, increased personal and economical recourses, leadership support, and leader development programs.
U.S. Department of Health & Human Services — The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed...
Hyde, Martin; Jappinen, Paavo; Theorell, Tores; Oxenstierna, Gabriel
New patterns of working, the globalisation of production and the introduction of information technologies are changing the way we work. This new working environment has eliminated some risks whilst introducing others. The importance of the psychosocial working environment for the health of employees is now well documented, but the effects of managerial style have received relatively little attention. Yet management is an increasingly important aspect of companies' policies. In this paper, we examine the relationship between conflict management in the workplace and self-reported measures of stress, poor general health, exhaustion and sickness absence due to overstrain or fatigue. Our sample consists of non-supervisory employees (N = 9309) working in the Swedish and Finnish plants of a multinational forestry company who were surveyed in 2000. Bivariate analyses show that those who report that differences are resolved through discussion are least likely to report stress, poor general health, exhaustion or sickness absence. Those who report that authority is used or that no attempts are made to resolve differences have quite similar rates across all measures. Binary logistic regression analyses were performed for all health outcomes controlling for age, sex, occupational group, job complexity, job autonomy and support from superiors. Results show significantly lower likelihoods of reporting stress, poor general health, exhaustion or sickness absence amongst employees who report that differences of opinion are resolved through discussion compared to those who report that no attempts are made. No significant differences were found between those who reported that differences were resolved through use of authority and subjects in the 'no attempt' category. These results suggest that the workplace conflict resolution is important in the health of employees in addition to traditional psychosocial work environment risk factors.
Gustafsson Sendén, Marie; Schenck-Gustafsson, Karin; Fridner, Ann
It is common that physicians go to work while sick and therefore it is important to understand the reasons behind. Previous research has shown that women and men differ in health and health related behavior. In this study, we examine gender differences among general practitioners who work while sick. General practitioners (GP's) working in outpatient care in a Swedish city participated in the study (n = 283; women = 63 %; response rate = 41 %). Data were obtained from a large web-based questionnaire about health and organization within primary care. Two questions about sickness presenteeism (going to work while sick) were included; life-long and during the past 12 months, and five questions about reasons. We controlled for general health, work-family conflict and demographic variables. Female physicians reported sickness presenteeism more often than male physicians. Work-family conflict mediated the association between gender and sickness presenteeism. Women reported reasons related with "concern for others" and "workload" more strongly than men. Men reported reasons related with "capacity" and "money" more strongly than women. These differences are likely effects of gender stereotyping and different family-responsibilities. Gender socialization and gender stereotypes may influence work and health-related behavior. Because sickness presenteeism is related with negative effects both on individuals and at organizational levels, it is important that managers of health organizations understand the reasons for this, and how gender roles may influence the prevalence of sickness presenteeism and the reasons that female and male GPs give for their behavior.
Peterson, H E; Lundin, P
This paper describes a documentation project to create, collect and preserve previously unavailable sources on informatics in Sweden (including health care as one of 16 subgroups), and making them available on the Web. Time was critical as the personal documentation and artifacts of early pioneers could be irretrievably lost. The criteria for participation were that a person had developed a system in a clinical environment which was used by others prior to 1980. Participants were interviewed and asked for early documentation such as notes, minutes from meetings, drawings, test results and early models - together with related artifacts. The approach included traditional oral history interviews, collection of autobiographies and new self-structuring and time saving methods, such as witness seminars and an Internet-based repository of their recollections (the Writers' Web). The combination of methods obtained new information on system errors, and challenges in reaching the goals due partly to inadequacies of the early technology, and partly to the insufficient understanding of the complexity of the many problems which needed to be solved before a useful electronic patient record could be realized. A very important result was the development of a method to collect information in an easier, faster and much less expensive way than using the traditional scientific method, and still reach results that are qualitative and quantitative for the purpose of documenting the early period of computer-based health care technology. The witness seminars and the Writers' Web yielded especially large amounts of hitherto-unknown information. With all material in one database available to everyone on the Web, it is accessed very frequently - especially by students, researchers, journalists and teachers. Study of the materials explains and clarifies the reasons behind the delays and difficulties that have been encountered in developing electronic patient records, as described in an
Mutual support societies for problem gamblers have existed in Sweden for 20 years. They have helped more people with gambling problems than any other institution inside or outside the Swedish health care system. This paper outlines the background of these societies and describes the meetings of one of them. Data come from interviews with members…
Kimber, Birgitta; Sandell, Rolf; Bremberg, Sven
Mental ill-health is a major problem worldwide. It includes depression, aggressive behavior, feeling down and alcohol and drug abuse. Since all children go to school, the school is an obvious arena for health interventions. A set of educational techniques named Social and Emotional Learning, based on the use by teachers of cognitive and behavioral methods, which teaches students self-control, social competence, empathy, motivation and self-awareness, has shown promising results in the USA. This paper reports on the application of similar techniques in Sweden (the Social and Emotional Training [SET] program). The study has a quasi-experimental longitudinal design, with two intervention and two control schools. A wide range of instruments, both Swedish and international, are employed. In this paper, results from the school years 1999-2000 (baseline) through to 2001-2002 are reported. Both the intervention and the data collection were performed by ordinary school staff in a routine school setting. Independent bi-annual ratings of teachers' performance were moderate to high, and teachers' perceptions of the program were generally, although by no means universally, high. However, their performance was poorer with regard to the collection of data. In terms of promotion, findings with regard to the impact of the program on mental health are generally favorable-in particular through the promotion of aspects of self-image, including well-being and the hindering of aggressiveness, bullying, attention-seeking and alcohol use. There was, however, no differential effect on social skills. It seems that SET has the potential to operate effectively as a health-promoting intervention during the school period, although its main impact may rather be to act as a brake on the deterioration in some aspects of mental health that is common during adolescence. Positively significant relationships were found on some but not all of the instrument scales, and effect sizes were medium.
Thunberg, Anna; Osvalder, Anna-Lisa (Dept. of Product and Production Development, Chalmers Univ. of Technology, Goeteborg (Sweden))
Research within the area of improving alarm system design and performance has mainly focused on new alarm systems. However, smaller modernisations of legacy systems are more common in the Swedish nuclear industry than design of totally new systems. This imposes problems when the new system should function together with the old system. This project deals with the special concerns raised by modernisation projects. The objective of the project has been to increase the understanding of the relationship between the operator's performance and the design of the alarm system. Of major concern has been to consider the cognitive abilities of the operator, different operator roles and work situations, and varying need of information. The aim of the project has been to complement existing alarm design guidance and to develop user-centred alarm design concepts. Different case studies have been performed in several industry sectors (nuclear, oil refining, pulp and paper, aviation and medical care) to identify best practice. Several empirical studies have been performed within the nuclear area to investigate the operator's need of information, performance and workload in different operating modes. The aspect of teamwork has also been considered. The analyses show that the operator has different roles in different work situations which affect both the type of information needed and how the information is processed. In full power operation, the interaction between the operator and the alarm system is driven by internal factors and the operator tries to maintain high situation awareness by actively searching for information. The operator wants to optimise the process and need detailed information with possibilities to follow-up and get historical data. In disturbance management, the operator is more dependent on external information presented by the alarm system. The new compilation of alarm guidance is based on the operator's varying needs in different working
Nyman Ann-Kristin J
Full Text Available Abstract Background Footrot is a world-wide contagious disease in sheep and goats. It is an infection of the epidermis of the interdigital skin, and the germinal layers of the horn tissue of the feet. The first case of footrot in Swedish sheep was diagnosed in 2004. Due to difficulties in distinguishing benign footrot from early cases of virulent footrot and because there is no possibility for virulence testing of strains of Dichelobacter nodosus in Sweden, the diagnosis is based of the presence or absence of clinical signs of footrot in sheep flocks. Ever since the first diagnosed case the Swedish Animal Health Service has worked intensively to stop the spread of infection and control the disease at flock level. However, to continue this work effectively it is important to have knowledge about the distribution of the disease both nationally and regionally. Therefore, the aims of this study were to estimate the prevalence of footrot in Swedish lambs at abattoirs and to assess the geographical distribution of the disease. Methods A prevalence study on footrot in Swedish lambs was performed by visual examination of 2000 feet from 500 lambs submitted from six slaughter houses. Each foot was scored according to a 0 to 5 scoring system, where feet with score ≥2 were defined as having footrot. Moreover, samples from feet with footrot were examined for Dichelobacter nodosus by culture and PCR. Results The prevalence of footrot at the individual sheep level was 5.8%, and Dichelobacter nodosus was found by culture and PCR in 83% and 97% of the samples from feet with footrot, respectively. Some minor differences in geographical distribution of footrot were found in this study. Conclusions In a national context, the findings indicate that footrot is fairly common in Swedish slaughter lambs, and should be regarded seriously.
Norström, Fredrik; Janlert, Urban; Hammarström, Anne
Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender. In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores. Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women. Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups
Full Text Available Abstract Background Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender. Methods In the Northern Swedish Cohort, 1083 teenagers (~16 years old were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores. Results Poor self-rated health in 2007 was reported among 43 of the 98 (44% unemployed and 159 (30% of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation and 0.10 (propensity score method. At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women. Conclusions Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of
showed that the appearance of daily load profiles, and thus the degree of matching to PV generation, are highly variable. Studies of matching of PV generation to aggregate domestic demand showed that load matching at moderate overproduction levels can be improved by PV panel orientation, demand side management (DSM) and storage. At high overproduction levels, however, the only impacting option is storage. Probabilistic power-flow simulations with the developed models yield a versatile picture of how impacts are distributed among customers and over time, as compared to often-used static simulations. Contrary to the trend towards higher time resolution in international research, hourly resolution was found to be sufficient for determining probability distributions for LV grid voltages. Power-flow simulations of three Swedish LV grids showed that a penetration level of 1 kWp PV systems at every customer was most beneficial in terms of on-site coverage of demand, counteracted voltage drops and decreased network losses. However, much higher penetration levels, up to the highest studied level of 5 kWp per household, can be handled without voltage rise above prescribed limits
Waste management is something that affects most people. The waste amounts are still increasing, but the waste treatment is changing towards recycling and integrated solutions. In Sweden producers' responsibility for different products, a tax and bans on deposition of waste at landfills implicates a reorganisation of the municipal solid waste management. Plans are made for new incineration plants, which leads to that waste combustion comes to play a role in the reorganisation of the Swedish energy system as well. The energy system is supposed to adapt to governmental decisions on decommission of nuclear plants and decreased use of fossil fuels. Waste from private households consists of hazardous waste, scrap waste, waste electronics and wastes that to a large extent are generated in the kitchen. The latter type has been studied in this thesis, except for newsprint, glass- and metal packages that by source separation haven't ended up in the waste bin. Besides the remaining amount of the above mentioned fractions, the waste consists of food waste, paper, cardboard- and plastic packages and inert material. About 80-90 % of this mixed household waste is combustible, and the major part of that is also possible to recycle. Several systems analyses of municipal solid waste management have been performed. Deposition at landfill has been compared to energy recovery, recycling of material (plastic and cardboard) and recycling of nutrients (in food waste). Environmental impact, fuel consumption and costs are calculated for the entire lifecycle from the households, until the waste is treated and the by-products have been taken care of. To stop deposition at landfills is the most important measure to take as to decrease the environmental impact from landfills, and instead use the waste as a resource, thereby substituting production from virgin resources (avoiding resource extraction and emissions). The best alternative to landfilling is incineration, but also material
Hjelm, Katarina; Berntorp, Kerstin; Apelqvist, Jan
This paper is a report on a study exploring beliefs about health and illness in women with gestational diabetes born in Sweden and Africa living in Sweden. A further aim is to study the influence of beliefs on self-care and care seeking. Extensive global migration leading to multicultural societies implies challenges to health care. Health/illness beliefs are culturally related and determine health-related behaviour, including self-care, which is crucial in management of gestational diabetes. The risk of developing gestational diabetes is increased in migrants, particularly of African origin, when residing in Western countries. No previous studies, except one, have been found comparing health/illness beliefs in women with gestational diabetes of different origin. Exploratory descriptive study. Semi-structured interviews. Consecutive sample of women diagnosed with gestational diabetes, 13 born in Sweden and 10 born in Africa, from a diabetes clinic in Sweden. Qualitative content analysis of data was applied. Beliefs were mainly related to individual and social factors. Health was described as freedom from disease and being healthy. Swedish women perceived heredity and hormonal changes as causing gestational diabetes, avoided work-related stress, had a healthy lifestyle, worried about the baby's health and development of type 2 diabetes, sought information, used more medications and health care and were on sick-leave more often because of pregnancy-related problems than African women, who did not know the cause of gestational diabetes, had a passive self-care attitude and followed prescriptions, often reported being told by staff that gestational diabetes would disappear after delivery and stated more pregnancy-related problems which they treated with rest or watchful waiting. Health/illness beliefs differed and affected self-care and care seeking. Lower risk awareness in African-born women was related to limited knowledge about the body and gestational diabetes
Fogelfors, Håkan; Wivstad, Maria; Eckersten, Henrik; Holstein, Fredrik; Johansson, Susanne; Verwijst, Theo
This strategic analysis of Swedish agriculture – production systems and agricultural landscapes in a time of change – focuses on climate change, future availability of natural resources and economic regulation in a global food market. The background to the project was that the Faculty of Natural Resources and Agriculture of the Swedish University of Agricultural Sciences identified an urgent need to explore the implications and opportunities of coming changes for agricultural production syste...
Friberg, Peter; Hagquist, Curt; Osika, Walter
The authors investigated self-perceived psychosomatic health in young people (10-24 years of age) in Sweden and analysed different samples during the years 2005 and 2007-2010 via a community website. Repeated cross-sectional surveys: (1) single question on a single day in 2005. (2) One specific question delivered on each of eight separate days in 2005. (3) The same eight questions delivered to smaller groups on the same day in 2007 and then again to randomly selected subjects in 2010. Validated questionnaires launched on the internet by a recognised Swedish community site. Study participants were invited to answer questions about their health with full anonymity as they logged into their personal area. 10-24-year-old children, adolescents and young adults. Self-reported psychosomatic health in terms of sex and age over time. A large number of responses were obtained (up to 140 000). The response rate for the single item on stress was 41%. A high percentage of young subjects responded that they felt stressed very often/often; the numbers were higher for women (47%) than for men (29%). Older teenaged women had more psychosomatic complaints than did men of similar ages; in contrast, among 10-12-year-old children, the percentage of psychosomatic complaints was similar for men and women. When comparing results obtained in 2010 with those obtained in 2007, young people of both sexes had a slightly better self-perceived health status in 2007. During the period 2005-2010 a high percentage of young people, particularly females, 16-18 years of age, had psychosomatic complaints and considered themselves as being often or very often stressed. These complaints were more pronounced in the older age groups. When directing questions to a large community, internet-based surveys appear to be valuable tools.
This report examines and compares the lobbying routes taken by Swedish and Norwegian energy-intensive industry firms during the revision of the European Emissions Trading System. Two key explanatory factors are in focus here - whether the company has its origin in the EU member state Sweden or in non-member Norway; and the size of the company. Six companies are chosen as cases: Norsk Hydro, Norcem and Norske Skog from Norway; and SSAB, Cementa and Svenska Cellulosa Aktiebolaget from Sweden. A key finding is the extensive use of European associations by all these firms in lobbying EU institutions. Also prevalent is the use of national associations, which would indicate benefits in the form of better institutional response to collective lobbying and resource-sharing aspects. Although Norwegian firms seem to have struggled more than Swedish firms when it comes to lobbying EU institutions, due to lack of access to the EU, not all differences can be explained by the fact of originating in an EU member state Sweden or non-member Norway. While company size has a positive effect on the number of available lobbying routes, this appears to depend on cross-border production and possibly other influences as well.(auth)
Henry Ford Health Systems evolved from a hospital into a system delivering care to 2.5 million patients and includes the Cancer Epidemiology, Prevention and Control Program, which focuses on epidemiologic and public health aspects of cancer.
Hammarström, Anne; Gustafsson, Per E; Strandh, Mattias; Virtanen, Pekka; Janlert, Urban
Research often fails to ascertain whether men and women are equally hit by the health consequences of unemployment. The aim of this study was to analyze whether men's self-reported health and health behaviour were hit more by unemployment than women's in a follow-up of the Northern Swedish Cohort. A follow-up study of a cohort of all school leavers in a middle-sized industrial town in northern Sweden was performed from age 16 to age 42. Of those still alive of the original cohort, 94% (n = 1,006) participated during the whole period. A sample was made of participants in the labour force and living in Sweden (n = 916). Register data were used to assess the length of unemployment from age 40 to 42, while questionnaire data were used for the other variables. In multivariate logistic regression analyses significant relations between unemployment and mental health/smoking were found among both women and men, even after control for unemployment at the time of the investigation and indicators of health-related selection. Significant relations between unemployment and alcohol consumption were found among women, while few visits to a dentist was significant among men. Men are not hit more by the health consequences of unemployment in a Swedish context, with a high participation rate of women in the labour market. The public health relevance is that the study indicates the need to take gendered contexts into account in public health research.
Full Text Available Background: Immigration to Sweden from lower latitude countries has increased in recent years. Studies in the general population in other Nordic countries have demonstrated that these groups are at risk of developing vitamin D deficiency, but studies in primary health care patients are rare. Objectives: The aim of this study is to examine possible differences in plasma-25(OH-vitamin D levels and intake of vitamin D between Swedish and immigrant female patients in a primary health care centre located at 60°N, where half of the inhabitants have an immigrant background. Another objective was to estimate what foods contribute with most vitamin D. Design: Thirty-one female patients from the Middle East and Africa and 30 from Sweden were recruited. P-25(OHD was measured and intake of vitamin D was estimated with a modified food frequency questionnaire (FFQ. Results: Vitamin D deficiency (plasma-25(OHD <25 nmol/L was common among immigrant women (61%. One immigrant woman and half of the Swedish women had optimal levels (plasma-25(OHD >50 nmol/L. There was a positive correlation between the intake of vitamin D from food and plasma-25(OHD. Only three women, all Swedish, reached the recommended intake of vitamin D from food. The immigrant women had lower intake compared to Swedish women (median: 3.1 vs. 5.1 µg/day. The foods that contributed with most vitamin D were fatty fish, fortified milk and margarine. Immigrant women consumed less fortified milk and margarine but more meat. Irrespective of origin, patients with plasma-25(OHD <25 nmol/L consumed less margarine but more meat. Conclusion: Vitamin D deficiency was common in the immigrant patients and their intake of vitamin D was lower. This highlights the need to target information about vitamin D to immigrant women in order to decrease the risk for vitamin D deficiency. The FFQ was well adapted to its purpose to estimate intake of vitamin D.
Ericsson, Karin (Lund Univ., Environmental and Energy Systems Studies, Lund (Sweden)). e-mail: email@example.com
The aim of this report is to describe the introduction and development of the Swedish DH systems and to identify what factors that have shaped this development. Elements that will be studied include for example the use of fuels and energy sources, CHP production, total DH supply, ownership and economics. Particular attention is paid to different policy incentives and regulations that directly or indirectly have influenced the DH systems. Non-policy factors that have shaped the district heating development are, however, also discussed. The main questions that are addressed in this report are: - What policy instruments and regulations have promoted, or in other ways influenced, the expansion of the DH systems? - What non-policy factors have influenced the expansion of the DH systems? - What policy instruments and regulations have influenced the use of fuels and energy sources, RES in particular, in DH production? - What non-policy factors have influenced the use of RES in DH production? The work behind this report was mainly conducted through literature studies using government official reports, reports from the Swedish Environmental Protection Agency, the Swedish Energy Agency and the Swedish District Heating Association, and academic publications encompassing articles in scientific journals, reports and PhD theses
Näslund, G K
The main objective of this study was to assess the health behavior, risk awareness and beliefs concerning the importance of positive health practices among blue-collar workers, and to examine the relationships between behavior, knowledge and beliefs. Data were gathered from 1359 workers aged 18-65 years using a postal questionnaire to 2493 randomly selected members of two labor unions. A high prevalence of negative health practices was noted among the respondents. While no relationship was found between health behaviors and awareness of risks associated with such behaviors, there was a relationship between positive health practices and strong beliefs about the importance of those practices. Awareness of the influence of a positive behavior on disease risk was associated with a stronger belief concerning the importance of that behavior. Women were characterized by having more positive health behavior, a higher level of risk awareness and stronger beliefs concerning the importance of positive health practices. It was concluded that while relationships were found between behavior and beliefs, and between beliefs and risk awareness, further research to establish the direction of the relationships is warranted.
Carlsson, Viktor; Hakeberg, Magnus; Wide Boman, Ulla
Dental anxiety (DA) is a common condition associated with avoidance of dental care and subsequent health-related and psychosocial outcomes, in what has been described as the vicious circle of DA. Also, recent studies have found an association between the psychosocial concept of sense of coherence (SOC) and DA. More studies are needed to verify the relationship between DA and SOC, especially using population-based samples. There is also a need for studies including factors related to the vicious circle of DA, such as oral health-related quality of life (OHRQoL), in order to further establish the correlates of DA in the general population. Therefore, the aim of this study was to investigate the relationship between DA and SOC, OHRQoL and health-related behaviour in the general Swedish population. The survey included a randomly selected sample of the adult Swedish population (N = 3500, age 19 - 96 years.). Data was collected by means of telephone interviews. Dental anxiety was measured with a single question. The SOC measure consisted of three questions conceptualising the dimensions of the SOC: comprehensibility, manageability and meaningfulness. The data collection also included the five-item version of the Oral Health Impact Profile (OHIP-5), as a measure of OHRQoL, as well as questions on oral health-related behaviour and socioeconomic status. Statistical analyses were made with descriptive statistics and inference testing using Chi-square, t--test and logistic regression. High DA was associated with low OHRQoL, irregular dental care and smoking. There was a statistically significant relationship between the SOC and DA in the bivariate, but not in the multivariate, analyses. Dental anxiety was not associated with oral health-related behaviour or socioeconomic status. This cross-sectional national survey gives support to the significant associations between high dental anxiety, avoidance of dental care and health-related outcomes, which may further reinforce the
UP-report. Energy systems studies. Basis of the Development platform. System to the Swedish Energy Agency's strategy work FOKUS; UP-rapport. Energisystemstudier. Underlag fraan Utvecklingsplattformen. System till Energimyndighetens strategiarbete FOKUS
Ingelstam, Lars; Alm, Maria
The report serves as input to the Swedish Energy Agency's strategies and priorities for research and innovation in the thematic area Energy systems studies for the period 2011 - 2016. The report has been compiled by members of the the Development platform System. This report provides background and circumstances for the energy system studies theme, and proposed priorities and activities for future efforts in this area. The development platform has contributed with valuable experience and knowledge that enabled the Swedish Energy Agency to then develop a strategy that meets the needs of society and business.
Integrating addiction and mental health treatment within a national addiction treatment system : Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems
Lundgren, Lena; Wilkey, Catriona; Chassler, Deborah; Sandlund, Mikael; Armelius, Bengt-Åke; Armelius, Kerstin; Brännström, Jan
AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data f...
Prell, Hillevi; Palmblad, Eva; Lissner, Lauren; Berg, Christina M
Food marketing influences children's food preferences and consumption and is important to consider in the prevention of child obesity. In this paper, health messages in commercials during children's peak viewing times were analysed by examining how food is articulated in the health discourse. In total, 82 food commercials from 66h of television recordings of the most popular commercial channels with children in Sweden (TV3, TV4 and Channel 5) were analysed with discourse theoretical tools according to Laclau and Mouffe and with a focus on rhetoric. Physical, mental and social health aspects were present in 71% of the commercials. Three health discourse types; a medical (food as protection and treatment), a hedonic (food as feeling good) and a social discourse type (food as caring) were discerned. In relation to these, the heart symbol, lifestyle associations and nature/the natural were elements that could be interpreted in different ways. Moreover, foods carrying unhealthy associations were promoted in the health discourse and presented as especially healthy by offensive rhetoric. The analysis raises awareness of the prevailing health messages in food marketing. Children and parents should be encouraged to develop their critical thinking about television food advertising and how it may influence social norms and dietary practices. Copyright © 2011 Elsevier Ltd. All rights reserved.
Juul, Annegrete; Krasnik, Allan; Rudkjøbing, Andreas
The Health Systems in Transition (HiT) series provide detailed descriptions of health systems in the countries of the WHO European Region as well as some additional OECD countries. An individual health system review (HiT) examines the specific approach to the organization, financing and delivery...... of health services in a particular country and the role of the main actors in the health system. It describes the institutional framework, process, content, and implementation of health and health care policies. HiTs also look at reforms in progress or under development and make an assessment of the health...... system based on stated objectives and outcomes with respect to various dimensions (health status, equity, quality, efficiency, accountability)....
Hildingsson, Ingegerd; Haines, Helen; Johansson, Margareta; Rubertsson, Christine; Fenwick, Jennifer
to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear. a longitudinal regional survey. Data were collected by three questionnaires. three hospitals in the middle-north part of Sweden. 1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth. childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear). expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience. expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress. this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term. Copyright
Hultin, Hanna; Lundberg, Michael; Lundin, Andreas; Magnusson, Cecilia
Previous studies indicate that the increasing educational level in many post-industrial nations may imply that subgroups of the population work in occupations for which they are overeducated. We aimed to investigate whether overeducation is associated with future self-rated health and psychological distress. The analytical sample consisted of 21,159 participants from the Stockholm Public Health Cohort. Individuals with upper secondary or university education, who in 2006 or 2007 had occupations requiring less education, were considered overeducated. The outcomes were self-rated health (SRH) and psychological distress in 2010. Overeducated women had an increased risk of less than good SRH, compared to university-educated women in matching occupations (adjusted odds ratios (OR): 2.44 confidence intervals (CI): 1.32-4.51 for overeducated women with secondary school education), but not compared to less educated women in the same occupational class (adjusted OR: 0.87 CI:0.32-2.38 for overeducated women with secondary school education). We found no increased risk of less than good SRH for overeducated men, and no association between overeducation and psychological distress for either sex. The results indicate that overeducation is not per se associated with onset of less than good SRH or psychological distress in a short-term perspective, and the findings support education expansion as a means of improving public health. © 2016 Foundation for the Sociology of Health & Illness.
Wallby, Thomas; Modin, Bitte; Hjern, Anders
Young age and lone parenthood are risk factors for impaired health among mothers and their children. Due to the higher risks of negative influences on physical and mental health, young and single mothers should be of special concern to the Child Health Services (CHS). In the present study, we investigated consumption patterns of child health care services among young and single mothers in Uppsala County, Sweden to study whether they are reached by the universal CHS program and if selective or indicative measures were administered in daily CHS practice. Register data on CHS contacts and socio-demographic indicators were collected for 10692 infants, born in 1998-2006. Results show small differences in contact pattern and immunization status, between children of young versus older, and single versus cohabiting mothers. However, both young (RR 0.64) and single (RR 0.80) mothers had significantly lower rates of participation in parental group. The CHS were consequently successful in implementing the universal preventive child health programme for all families, including families with young or single mothers. There was no indication, however, of an established selective preventive strategy aimed at these high risk families. Programs for strengthening the support provided to vulnerable families by the CHS are needed. © The Author(s) 2012.
Nymberg, Peter; Drevenhorn, Eva
In Sweden, 56% of the population aged 16-84 have an unhealthy lifestyle. The primary health care (PHC) has been instructed to offer citizens health promotion and disease-preventive actions. Very few studies have been conducted about how individuals experience interventions from the PHC intended to help them to change lifestyle. The purpose of the study was to explore patients' experiences of visiting a nurse-led lifestyle clinic. Patients (n = 137), who participated in a screening test at a lifestyle clinic, were invited to focus group interviews. Of these, 14 patients agreed to participate. The data were analysed using content analysis. The patients felt that the visit to the lifestyle clinic gave insight into their habits and diminished their fear of not being healthy. Primary health care was seen as a safe provider in this matter. Disappointment was occasioned by the unfulfilled expectations of blood tests, lack of follow-up visit and inconsistencies of approach during the visit to the lifestyle clinic. Personal chemistry was perceived to be crucial for how the encounter with the public health nurse evolved. Lifestyle clinics can give patients opportunity to change lifestyle and also to confirm the good habits. It may also be important to have follow-up visits to give the patients' support when changing lifestyle. Nurses counselling patients about lifestyle changes need to have recurrent training in Motivational Interviewing. © 2015 Nordic College of Caring Science.
Full Text Available Many unhealthy behaviors are created during adolescence and follow the individual into adulthood. In addition, health behaviors often occur in clusters as those who are inactive are more likely to eat unhealthy food and smoke. This makes the early foundation of healthy behaviors vital. The aim was to describe and develop an understanding of adolescents’ awareness and experiences concerning health promotion. Data was collected using focus groups with a total of 28 seventh graders and was analysed with latent qualitative content analysis. One main theme was identified; being competent, ambivalent and creative at the same time. The following three subthemes also emerged: being a digital native for better and for worse, knowing what is healthy, and sometimes doing it, and considering change and having ideas of how change could be supported. The main theme elucidates how the majority of students were informed and able but they did not always prioritize their health. The concept of health promotion relies upon the engagement of the individual; however, although the students had clear ideas about how they would like to change their own behaviors, they felt a need for support. Interestingly, the students were able to make several suggestions about the kind of support that would make a difference to their adoption to more healthy modes of living. They suggested information and communication technology (ICT, for example encouraging text messages (SMS, and social support, for example parents setting rules and peers inspiring them to adhere to a healthy behavior. The knowledge gained from this study echoes our view of inclusion and this could be helpful for those who encounter the challenge of promoting health among adolescents.
Lekhan, Valery; Rudiy, Volodymyr; Shevchenko, Maryna; Nitzan Kaluski, Dorit; Richardson, Erica
This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system. World Health Organization 2015 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Döring, Nora; Hansson, Lena M; Andersson, Elina Scheers
: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75......-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme. TRIAL REGISTRATION: ISRCTN16991919.......BACKGROUND: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting...
Full Text Available Abstract Background Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting. Methods Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI. The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score Results The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only. Conclusions Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.
Strömberg, Ranja; Backlund, Lars G; Löfvander, Monica
Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting. Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥ 10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only. Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.
Murauskiene, Liubove; Janoniene, Raimonda; Veniute, Marija; van Ginneken, Ewout; Karanikolos, Marina
This analysis of the Lithuanian health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance since 2000.The Lithuanian health system is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population amounting to about half of its budget. Public financing of the health sector has gradually increased since 2004 to 5.2 per cent of GDP in 2010.Although the Lithuanian health system was tested by the recent economic crisis, Lithuanias counter-cyclical state health insurance contribution policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines.Yet the future impact of cuts in public health spending is a cause for concern. In addition, out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups.A number of challenges remain. The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients. Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer provider relationship. Finally, population health,albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Full Text Available The Risk Drinking Project was a national implementation endeavour in Sweden, carried out from 2004 to 2010, based on a government initiative to give alcohol issues a more prominent place in routine primary, child, maternity and occupational health care. The article describes and analyses the project. Critical factors that were important for the results are identified. The magnitude of the project contributed to its reach and impact in terms of providers’ awareness of the project goals and key messages. The timing of the project was appropriate. The increase in alcohol consumption in Sweden and diminished opportunities for primary prevention strategies since entry to the European Union in 1995 have led to increased expectations for health care providers to become more actively involved in alcohol prevention. This awareness provided favourable conditions for this project. A multifaceted approach was used in the project. Most educational courses were held in workshops and seminars to encourage learning-by-doing. Motivational interviewing was an integral aspect. The concept of risk drinking was promoted in all the activities. Subprojects were tailored to the specific conditions of each respective setting, building on the skills the providers already had to modify existing work practices. Nurses were afforded a key role in the project.
Fahlen, E.; Ahlgren, E.O. [Energy Systems Technology, Division of Energy Technology, Department of Energy and Environment, Chalmers University of Technology, SE-412 96 Goeteborg (Sweden)
Sweden has historically had strict emission control by implementation of economic policy instruments with the aim of internalising the external costs of air pollution. This study aims to evaluate how well current Swedish policy instruments reflect the environmental costs associated with heat generation in several district-heating (DH) plants in the DH system of Goeteborg. Furthermore, it aims to simulate and evaluate the operation of the DH system based on its social cost-effectiveness which takes into account the DH system's private and external costs (non-internalised environmental costs). The study shows that the economic policy instruments do not fully internalise all external costs whereas for certain technologies, the costs in terms of taxes, emission permits, environmental fees, etc. are higher than the environmental costs caused by the pollutants, given the environmental cost estimates used in the study. The simulation results show that the deviating internalisation of external costs affects the economic ranking of the different plants within the studied DH system. The estimated loss in social-cost effectiveness of the operation of the DH system of Goeteborg is noticable but relatively small if compared to the variable heat generation costs for most of the studied DH plants. (author)
Fahlen, E., E-mail: firstname.lastname@example.org [Energy Systems Technology, Division of Energy Technology, Department of Energy and Environment, Chalmers University of Technology, SE-412 96 Goeteborg (Sweden); Ahlgren, E.O. [Energy Systems Technology, Division of Energy Technology, Department of Energy and Environment, Chalmers University of Technology, SE-412 96 Goeteborg (Sweden)
Sweden has historically had strict emission control by implementation of economic policy instruments with the aim of internalising the external costs of air pollution. This study aims to evaluate how well current Swedish policy instruments reflect the environmental costs associated with heat generation in several district-heating (DH) plants in the DH system of Goeteborg. Furthermore, it aims to simulate and evaluate the operation of the DH system based on its social cost-effectiveness which takes into account the DH system's private and external costs (non-internalised environmental costs). The study shows that the economic policy instruments do not fully internalise all external costs whereas for certain technologies, the costs in terms of taxes, emission permits, environmental fees, etc. are higher than the environmental costs caused by the pollutants, given the environmental cost estimates used in the study. The simulation results show that the deviating internalisation of external costs affects the economic ranking of the different plants within the studied DH system. The estimated loss in social-cost effectiveness of the operation of the DH system of Goeteborg is noticable but relatively small if compared to the variable heat generation costs for most of the studied DH plants.
Full Text Available The article presents a sustainability assessment of the beet-to-sugar production system in Sweden from 2003 until 2015. It focuses on the life-cycle phases of beet growing, beet transport and sugar processing. Based on the Swedish sustainable development strategy, eight indicators in environmental and socio-economic domains based significantly on EU price and production quota changes are assessed. The study also appraises the autumn wheat-to-flour production system as an alternative scenario to provide a better understanding of the overall impacts on the region of the effects of the EU price and quota changes. The method used is a system analysis (simulation model developed with the software STELLA 9.1. The study is a part of a broader regional sustainability assessment that focuses on the sugar sector in Sweden. Model results of the combined sugar and flour systems show general declines in agricultural landscape diversity and revenues earned in the region with only slight decreases in the number of full-time jobs in the region. Results also reveal decreases in the amount of nutrient runoff, fossil fuel energy use, greenhouse gas releases and field chemical use, with more substantial decreases in biodiversity via the suspension of organic beet growing in the region.
Lindgren, T; Norbäck, D
Health symptoms and perception of cabin air quality (CAQ) among commercial cabin crew were studied as a function of personal risk factors, occupation, and work on intercontinental flights with exposure to environmental tobacco smoke (ETS). A standardized questionnaire (MM 040 NA) was mailed in February to March 1997 to all Stockholm airline crew on duty in a Scandinavian airline (n=1857), and to office workers from the same airline (n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% (n=1513) by the airline crew, and 77% (n=168) by the office group. Statistical analysis was performed by multiple logistic regression analysis, controlling for age, gender, atopy, current smoking habits, and occupation. The most common symptoms among airline crew were: fatigue (21%), nasal symptoms (15%), eye irritation (11%), dry or flushed facial skin (12%), and dry/itchy skin on hands (12%). The most common complaint about CAQ was dry air (53%). Airline crew had more nasal, throat, and hand skin symptoms, than office workers did. Airline crew with a history of atopy had more nasal, throat, and dermal face and hand symptoms than other crew members did. Older airline crew members had more complaints of difficulty concentrating, but fewer complaints of dermal symptoms on the face and hands than younger crew members did. Female crew members reported more headaches than male crew members reported. Smoking was not associated with frequency of symptoms. Pilots had fewer complaints of most symptoms than other crew had. Airline crew that had been on an intercontinental flight in the week before the survey had more complaints of fatigue, heavy-headedness, and difficulty concentrating. Complaints of stuffy air and dry air were more common among airline crew than among office workers from the same airline. Female crew had more complaints of stuffy and dry air than male crew had. Older cabin crew had fewer complaints of dry air than
Ericsson, Jessica S; Wennström, Jan L; Lindgren, Björn; Petzold, Max; Östberg, Anna-Lena; Abrahamsson, Kajsa H
To test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents. Five hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents' education level. In the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with 'tooth-brushing ≥ 2 times daily' as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators 'no/few missed dental appointments', 'no tobacco use' and 'weekly exercise', theoretical studies were statistically significant and positively associated. In the investment model with 'perceived oral health care attention' as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth. Individual, environmental and lifestyle factors are associated with young individuals' oral health investment behaviours and gingival health conditions.
Feltelius, Nils; Gedeborg, Rolf; Holm, Lennart; Zethelius, Björn
The aim of this study was to describe content and procedures in some selected Swedish health care quality registries (QRs) of relevance to regulatory decision-making. A workshop was organized with participation of seven Swedish QRs which subsequently answered a questionnaire regarding registry content on drug treatments and outcomes. Patient populations, coverage, data handling and quality control, as well as legal and ethical aspects are presented. Scientific publications from the QRs are used as a complementary measure of quality and scientific relevance. The registries under study collect clinical data of high relevance to regulatory and health technology agencies. Five out of seven registries provide information on the drug of interest. When applying external quality criteria, we found a high degree of fulfillment, although information on medication was not sufficient to answer all questions of regulatory interest. A notable strength is the option for linkage to the Prescribed Drug Registry and to information on education and socioeconomic status. Data on drugs used during hospitalization were also collected to some extent. Outcome measures collected resemble those used in relevant clinical trials. All registries collected patient-reported outcome measures. The number of publications from the registries was substantial, with studies of appropriate design, including randomized registry trials. Quality registries may provide a valuable source of post-marketing data on drug effectiveness, safety, and cost-effectiveness. Closer collaboration between registries and regulators to improve quality and usefulness of registry data could benefit both regulatory utility and value for health care providers.
De Pietro, Carlo; Camenzind, Paul; Sturny, Isabelle; Crivelli, Luca; Edwards-Garavoglia, Suzanne; Spranger, Anne; Wittenbecher, Friedrich; Quentin, Wilm
This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to
The Swedish Energy Market, 2005 is an annual publication that presents information and statistics on the network based energy markets in Sweden, i.e. the markets for electricity, natural gas and district heating. It also provides an overview of the issues that have arisen on these markets during the second half of 2004 and the first half of 2005. Considerable work is being carried out in the EU on creating a single market for electricity and natural gas. This publication therefore describes expansion of the Swedish market towards a Nordic and a European market. The publication normally includes a theme chapter, describing some event of particular interest for the Swedish energy market during the year. This year, the theme chapter is devoted to the Storm Gudrun, which struck the south of the country at the beginning of January, and its effects on electricity supply throughout the country. The chapter is based on the report submitted to the Government by the Energy Markets Inspectorate in the spring of 2005, and also includes a summary of the Inspectorate's proposals for measures to improve the security of electricity transmission. Energy in Sweden, which is another of the Swedish Energy Agency's annual publications, provides information and statistics on the development of the entire Swedish energy system.
Sagan, Anna; Panteli, Dimitra; Borkowski, W; Dmowski, M; Domanski, F; Czyzewski, M; Gorynski, Pawel; Karpacka, Dorota; Kiersztyn, E; Kowalska, Iwona; Ksiezak, Malgorzata; Kuszewski, K; Lesniewska, A; Lipska, I; Maciag, R; Madowicz, Jaroslaw; Madra, Anna; Marek, M; Mokrzycka, A; Poznanski, Darius; Sobczak, Alicja; Sowada, Christoph; Swiderek, Maria; Terka, A; Trzeciak, Patrycja; Wiktorzak, Katarzyna; Wlodarczyk, Cezary; Wojtyniak, B; Wrzesniewska-Wal, Iwona; Zelwianska, Dobrawa; Busse, Reinhard
Since the successful transition to a freely elected parliament and a market economy after 1989, Poland is now a stable democracy and is well represented within political and economic organizations in Europe and worldwide. The strongly centralized health system based on the Semashko model was replaced with a decentralized system of mandatory health insurance, complemented with financing from state and territorial self-government budgets. There is a clear separation of health care financing and provision: the National Health Fund (NFZ) the sole payer in the system is in charge of health care financing and contracts with public and non-public health care providers. The Ministry of Health is the key policy-maker and regulator in the system and is supported by a number of advisory bodies, some of them recently established. Health insurance contributions, borne entirely by employees, are collected by intermediary institutions and are pooled by the NFZ and distributed between the 16 regional NFZ branches. In 2009, Poland spent 7.4% of its gross domestic product (GDP) on health. Around 70% of health expenditure came from public sources and over 83.5% of this expenditure can be attributed to the (near) universal health insurance. The relatively high share of private expenditure is mostly represented by out-of-pocket (OOP) payments, mainly in the form of co-payments and informal payments. Voluntary health insurance (VHI) does not play an important role and is largely limited to medical subscription packages offered by employers. Compulsory health insurance covers 98% of the population and guarantees access to a broad range of health services. However, the limited financial resources of the NFZ mean that broad entitlements guaranteed on paper are not always available. Health care financing is overall at most proportional: while financing from health care contributions is proportional and budgetary subsidies to system funding are progressive, high OOP expenditures
de Almeida Simoes, Jorge; Augusto, Goncalo Figueiredo; Fronteira, Ines; Hernandez-Quevedo, Cristina
This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65. Health inequalities remain a general problem in the country. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Out-of-pocket payments have been increasing over time, not only co-payments, but particularly direct payments for private outpatient consultations, examinations and pharmaceuticals. The level of cost-sharing is highest for pharmaceutical products. Between one-fifth and one-quarter of the population has a second (or more) layer of health insurance coverage through health subsystems (for specific sectors or occupations) and voluntary health insurance (VHI). VHI coverage varies between schemes, with basic schemes covering a basic package of services, whereas more expensive schemes cover a broader set of services, including higher ceilings of health care expenses. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gate-keeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included
Ahlvin, Anna; Gerdin, Elisabeth Wärnberg; Bågesund, Mats; Ordell, Sven
For decades, Swedish dental professionals have collected clinical epidemiological data from the dental records. To supplement the epidemiology, Ostergötland County Council decided to examine patient perceptions of oral health: self-rated knowledge, self-perceived oral health, and opinions about oral health. The aim was to compare self-perceived oral health among 19-year-olds to determine differences between genders, various municipalities and between 2004 and 2011. This study analysed the responses from two cross-sectional surveys of the entire population of 19-year-olds in Ostergötland County, Sweden, performed in 2004 and 2011. Of the 2,413 (53%) (50% men, 50% women) 19-year-olds who responded to the questionnaire in 2004 and the 3,803 (67%) (50% men, 50% women) in 2011, most 19-year-olds (88.1%  and 87.5 % ) reported satisfaction with their oral health. Around half of the respondents rated their knowledge on periodontitis as low. Boys rated their knowledge about avoiding periodontitis higher than girls (p pain. In 2011 that figure was 83.7%.The respondents expressed some uncertainty about the benefits of fluoride toothpaste (7.5% in 2004 and 9.3% in 2011), especially the boys (10.3% in 2004 and 10.5% in 2011). Girls reported both a higher social impact and greater concern about aesthetics related to their oral health. They also reported headache (27.5%) nearly twice as often as boys (14.2%) (p > 0.001). Responses between the municipalities did not differ, with the exception of items regarding periodontitis. Thus, this study found indications that perceptions of oral health and knowledge in Ostergötland County complied with Swedish Dental Act. The study also found patient perceptions of oral health among 19-year-olds to be good.
Bejerot, E; Söderfeldt, B; Aronsson, G; Härenstam, A; Söderfeldt, M
Two aspects of Human Resource Management (HRM), a main trend in modern personnel management, are considered in this study: A 'hard' version stressing performance monitoring and competition, and a 'soft' version stressing communication with employees. The aim of the investigation was to examine whether these two aspects of modern management are reflected in dentists' perceptions of differences in work conditions compared with other professionals. A questionnaire was answered by 312 publicly employed dentists and 3,600 other professionals in Sweden. The response rate was 66-77%. Effects from HRM on work, conditions and perceived efficiency were confirmed. The interaction effects, reflecting the duality of HRM, resulted in poorer work conditions, e.g. worse balance between effort and reward and worse opportunities for developing competence and collaboration in the workplace. This pertains especially in the case of dentists, where the positive effects of 'soft' HRM did not compensate for the negative effects of 'hard' HRM. Dentists in Sweden's Public Dental Health Service appear as a vulnerable group among Swedish professionals.
Ibraimova, Ainura; Akkazieva, Baktygul; Ibraimov, Aibek; Manzhieva, Elina; Rechel, Bernd
Kyrgyzstan has undertaken wide-ranging reforms of its health system in a challenging socioeconomic and political context. The country has developed two major health reform programmes after becoming independent: Manas (1996 to 2006) and Manas Taalimi (2006 to 2010). These reforms introduced comprehensive structural changes to the health care delivery system with the aim of strengthening primary health care, developing family medicine and restructuring the hospital sector.Major service delivery improvements have included the introduction of new clinical practice guidelines, improvements in the provision and use of pharmaceuticals, quality improvements in the priority programmes for mother and child health, cardiovascular diseases, tuberculosis and HIV/AIDS, strengthening of public health and improvements in medical education. A Community Action for Health programme was introduced through new village health committees, enhancing health promotion and allowing individuals and communities to take more responsibility for their own health. Health financing reform consisted of the introduction of a purchaser provider split and the establishment of a single payer for health services under the state-guaranteed benefit package (SGBP). Responsibility for purchasing health services has been consolidated under the Mandatory Health Insurance Fund (MHIF), which pools general revenue and health insurance funding. Funds have been pooled at national level since 2006, replacing the previous pooling at oblast level. The transition from oblast-based pooling of funds to pooling at the national level allowed the MHIF to distribute funds more equitably for the SGBP and the Additional Drug Package. Although utilization of both primary care and hospital services declined during the 1990s and early 2000s, it is increasing again. There is increasing equality of access across regions, improved financial protection and a decline in informal payments, but more efforts will be required in these
Full Text Available Background . The Inuit are an indigenous people totalling about 160,000 and living in 4 countries across the Arctic – Canada, Greenland, USA (Alaska and Russia (Chukotka. In essence, they are one people living in 4 countries. Although there have been significant improvements in Inuit health and survival over the past 50 years, stark differences persist between the key health indicators for Inuit and those of the national populations in the United States, Canada and Russia and between Greenland and Denmark. On average, life expectancy in all 4 countries is lower for Inuit. Infant mortality rates are also markedly different with up to 3 times more infant deaths than the broader national average. Underlying these statistical differences are a range of health, social, economic and environmental factors which have affected Inuit health outcomes. Although the health challenges confronting the Inuit are in many cases similar across the Arctic, the responses to these challenges vary in accordance with the types of health systems in place in each of the 4 countries. Each of the 4 countries has a different health care system with varying degrees of accessibility and affordability for Inuit living in urban, rural and remote areas. Objective . To describe funding and governance arrangements for health services to Inuit in Canada, Greenland, USA (Alaska and Russia (Chukotka and to determine if a particular national system leads to better outcomes than any of the other 3 systems. Study design . Literature review. Results . It was not possible to draw linkages between the different characteristics of the respective health systems, the corresponding financial investment and the systems’ effectiveness in adequately serving Inuit health needs for several reasons including the very limited and inadequate collection of Inuit-specific health data by Canada, Alaska and Russia; and second, the data that are available do not necessarily provide a feasible point of
Tatar, Mehtap; Mollahaliloğlu, Salih; Sahin, Bayram; Aydin, Sabahattin; Maresso, Anna; Hernández-Quevedo, Cristina
Turkey has accomplished remarkable improvements in terms of health status in the last three decades, particularly after the implementation of the Health Transformation Program (HTP (Saglikta Donus, um Programi)). Average life expectancy reached 71.8 for men and 76.8 for women in 2010. The infant mortality rate (IMR) decreased to 10.1 per 1000 live births in 2010, down from 117.5 in 1980. Despite these achievements, there are still discrepancies in terms of infant mortality between rural and urban areas and different parts of the country, although these have been diminishing over the years. The higher infant mortality rates in rural areas can be attributed to low socioeconomic conditions, low female education levels and the prevalence of infectious diseases. The main causes of death are diseases of the circulatory system followed by malignant neoplasms. Turkeys health care system has been undergoing a far-reaching reform process (HTP) since 2003 and radical changes have occurred both in the provision and the financing of health care services. Health services are now financed through a social security scheme covering the majority of the population, the General Health Insurance Scheme (GHIS (Genel Saglik Sigortasi)), and services are provided both by public and private sector facilities. The Social Security Institution (SSI (Sosyal Guvenlik Kurumu)), financed through payments by employers and employees and government contributions in cases of budget deficit, has become a monopsonic (single buyer) power on the purchasing side of health care services. On the provision side, the Ministry of Health (Saglik Bakenligi) is the main actor and provides primary, secondary and tertiary care through its facilities across the country. Universities are also major providers of tertiary care. The private sector has increased its range over recent years, particularly after arrangements paved the way for private sector provision of services to the SSI. The most important reforms since
Wahn, Elisabeth Hertfelt; Nissen, Eva
Among Swedish pregnant teenage girls it is unusual to continue pregnancy and to choose to have a baby. Swedish teenage mothers can therefore be expected to differ from adult mothers, at a group level. The aim of this study was to describe and compare teenage mothers who were giving birth in hospital with adult mothers as to sociodemographic background, perception of health and social support. A descriptive comparative study was conducted over one year, in a county in south-western Sweden, which comprised a group of all teenage mothers aged 15-19, who gave birth at hospital (study group n=97) and the same number of adult mothers aged 25-29, matched for parity and birth of a baby closest to the index mother (reference group). Both groups answered a questionnaire regarding sociodemographic variables, lifestyle, health, self-esteem, depressive symptoms, and support. Information on the mothers' pregnancy and delivery was obtained from their maternal health and delivery charts. Teenage mothers had more often been exposed to a difficult family situation, had more often experienced school failure than adult mothers, and showed health-risk behavior. Teenage mothers perceived less support, had lower self-esteem, and more depressive symptoms than adult mothers. Teenage mothers differed from adult mothers regarding family situation and health behavior as well as perception of support, self-esteem, and depressive symptoms, which may negatively influence their ability to cope with parenthood. Efforts should be made early in pregnancy to meet both health and support needs of teenage mothers.
Gaal, Peter; Szigeti, Szabolcs; Csere, Marton; Gaskins, Matthew; Panteli, Dimitra
Hungary has achieved a successful transition from an overly centralized, integrated Semashko-style health care system to a purchaser provider split model with output-based payment methods. Although there have been substantial increases in life expectancy in recent years among both men and women, many health outcomes remain poor, placing Hungary among the countries with the worst health status and highest rate of avoidable mortality in the EU (life expectancy at birth trailed the EU27 average by 5.1 years in 2009). Lifestyle factors especially the traditionally unhealthy Hungarian diet, alcohol consumption and smoking play a very important role in shaping the overall health of the population.In the single-payer system, the recurrent expenditure on health services is funded primarily through compulsory, non-risk-related contributions made by eligible individuals or from the state budget. The central government has almost exclusive power to formulate strategic direction and to issue and enforce regulations regarding health care. In 2009 Hungary spent 7.4% of its gross domestic product (GDP) on health, with public expenditure accounting for 69.7% of total health spending, and with health expenditure per capita ranking slightly above the average for the new EU Member States, but considerably below the average for the EU27 in 2008. Health spending has been unstable over the years, with several waves of increases followed by longer periods of cost-containment and budget cuts. The share of total health expenditure attributable to private sources has been increasing, most of it accounted for by out-of-pocket (OOP) expenses. A substantial share of the latter can be attributed to informal payments, which are a deeply rooted characteristic of the Hungarian health system and a source of inefficiency and inequity. Voluntary health insurance, on the other hand, amounted to only 7.4% of private and 2.7% of total health expenditure in 2009. Revenue sources for health have been
Angelstam, Per; Andersson, Kjell; Isacson, Maths; Gavrilov, Dmitri V; Axelsson, Robert; Bäckström, Mattias; Degerman, Erik; Elbakidze, Marine; Kazakova-Apkarimova, Elena Yu; Sartz, Lotta; Sädbom, Stefan; Törnblom, Johan
Barriers and bridges to implement policies about sustainable development and sustainability commonly depend on the past development of social-ecological systems. Production of metals required integration of use of ore, streams for energy, and wood for bioenergy and construction, as well as of multiple societal actors. Focusing on the Swedish Bergslagen region as a case study we (1) describe the phases of natural resource use triggered by metallurgy, (2) the location and spatial extent of 22 definitions of Bergslagen divided into four zones as a proxy of cumulative pressure on landscapes, and (3) analyze the consequences for natural capital and society. We found clear gradients in industrial activity, stream alteration, and amount of natural forest from the core to the periphery of Bergslagen. Additionally, the legacy of top-down governance is linked to today's poorly diversified business sector and thus municipal vulnerability. Comparing the Bergslagen case study with other similar regions in Russia and Germany, we discuss the usefulness of multiple case studies.
Full Text Available This article studies the process of transformation of the Swedish political party system in the 1980s. The study aims to develop a typology of the Swedish political party system before and after the transformation processes commenced. The article identifies the key prerequisites for such transformation: the crisis of social democracy and an increase in the nationalist attitudes in the society caused by the negative repercussions of the system of integration of migrants into the society based on the multiculturalism principles. The interethnic tension manifested itself in the wide support for the Swedish Democrats Party in the 2010 parliamentary election. From a political party system dominated by social democrats, the Swedish political party system turned into one with two leading parties – the centre-left Swedish Social Democratic Labour Party and the centre-right Moderate Party. The Swedish Democrats position themselves as an alternative to the two party blocs headed by the dominating parties (the Alliance and the Red-Green. The study employs an interdisciplinary approach in the framework of science synthesis. Its results can be of practical significance for politicians, social activists, and academicians.
researchers work alongside health sector workers and decision-makers to strengthen state capacity to produce and apply scientifically grounded evidence. They empower communities to play a foundational role in shaping and monitoring their own health systems. And through GEHS, techno- logical innovation is supported ...
Carlsson, F; Karlson, B; Ørbaek, P; Osterberg, K; Ostergren, P-O
Self-reported annoyance from electrical equipment has been in evidence since the mid-1980s, and the first reports of illness from everyday chemicals arose in the 1960s. However, the extent of the problem has not yet been fully established. The aim of this study was to estimate the prevalence of annoyance related to electrical and chemical factors in a Swedish general population, and to assess possible relationships with subjective health and daily functioning. In total, 13,604 subjects, representative of the population of Scania, Sweden, answered a survey containing five questions regarding annoyance from five environmental factors: fluorescent tube lighting, visual display units, other electrical equipment, air that smells of chemicals, and other smells. The survey also obtained data on self-reported health (SRH-7), mental well-being [General Health Questionnaire (GHQ)-12], work situation and daily functioning. Almost one-third of the respondents reported annoyance from at least one environmental factor. Annoyance was more frequent among women, subjects of working age and immigrants. Subjects who reported environmental annoyance scored higher on GHQ-12 and lower on SRH-7, indicating impaired subjective physical and mental well-being. They were also more likely to report deteriorated daily functioning. Annoyance related to electrical and/or chemical factors was common in a Swedish population. Subjects reporting environmental annoyance rated their overall health significantly poorer than the general population. The association with subjective health and functional capacity increased with severity of annoyance, which suggests that there is some connection between environmental annoyance, well-being and functional capacity.
Franzén, Stefan; Janson, Christer; Larsson, Kjell; Petzold, Max; Olsson, Urban; Magnusson, Gunnar; Telg, Gunilla; Colice, Gene; Johansson, Gunnar; Sundgren, Mats
In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma. EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates. We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m2 versus 27.3 kg/m2; and consisted of 40% versus 34% males. The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.
Barry, Tom; Cunningham, Harry
Viewgraphs and discussion of onboard system health assessment are presented. Success of the space station program will be measured by how well it addresses the basic requirements for (1) maintaining the orbiting Space Station Freedom fully operational for its projected life of thirty years, and (2) the cost-effective execution of the overall space station program. Onboard system health assessment must provide complete and thorough testing capabilities along with effective associated redundancy/fault management.
This article suggests an enrichment of the standard method for decomposition of the concentration index to account for unobserved heterogeneity and persistence in health behavior. As the underlying regression model in the decomposition, this approach uses a dynamic random-effect probit that both consider individual heterogeneity, using a Mundlak type of specification, and applies a simple solution to account for smoking persistence. I illustrate the suggested approach using a panel of Swedish women in Statistics Sweden's Survey of Living Conditions for one vital health-related behavior, smoking. The results highlight the importance of persistence and show that education and living in a single household are the main drivers of income-related smoking inequality. Copyright © 2017 John Wiley & Sons, Ltd.
Nilses, Carin; Persson, Margareta; Lindkvist, Marie; Petersson, Kerstin; Mogren, Ingrid
The aim was to investigate maternal background factors' significance in relation to risk of elective and emergency caesarean sections (CS) in Sweden. Population-based, retrospective, cross-sectional study. The Swedish Maternal Health Care Register (MHCR) is a national quality register that collects data on pregnancy, delivery and postpartum period. All women registered in MHCR 2011 to 2012 were included in the study sample (N = 178,716). The risk of elective and emergency caesarean section in relation to age, parity, education, country of origin, weight in early pregnancy and weight gain during pregnancy was calculated in logistic regression models. Multiparous women demonstrated a doubled risk of elective CS compared to primiparous women, but their risk for emergency CS was halved. Overweight and obesity at enrolment in antenatal care increased the risk for emergency CS, irrespective of parity. Weight gain above recommended international levels (Institute of Medicine, IOM) during pregnancy increased the risk for emergency CS for women with normal weight, overweight or obesity. There is a need of national guidelines on recommended weight gain during pregnancy in Sweden. We suggest that the usefulness of the IOM guidelines for weight gain during pregnancy should be evaluated in the Swedish context. Copyright © 2016 Elsevier B.V. All rights reserved.
Azzopardi-Muscat, Natasha; Buttigieg, Stefan; Calleja, Neville; Merkur, Sherry
Maltese life expectancy is high, and Maltese people spend on average close to 90% of their lifespan in good health, longer than in any other EU country. Malta has recently increased the proportion of GDP spent on health to above the EU average, though the private part of that remains higher than in many EU countries. The total number of doctors and GPs per capita is at the EU average, but the number of specialists remains relatively low; education and training are being further strengthened in order to retain more specialist skills in Malta. The health care system offers universal coverage to a comprehensive set of services that are free at the point of use for people entitled to statutory provision. The historical pattern of integrated financing and provision is shifting towards a more pluralist approach; people already often choose to visit private primary care providers, and in 2016 a new public-private partnership contract for three existing hospitals was agreed. Important priorities for the coming years include further strengthening of the primary and mental health sectors, as well as strengthening the health information system in order to support improved monitoring and evaluation. The priorities of Malta during its Presidency of the Council of the EU in 2017 include childhood obesity, and Structured Cooperation to enhance access to highly specialized and innovative services, medicines and technologies. Overall, the Maltese health system has made remarkable progress, with improvements in avoidable mortality and low levels of unmet need. The main outstanding challenges include: adapting the health system to an increasingly diverse population; increasing capacity to cope with a growing population; redistributing resources and activity from hospitals to primary care; ensuring access to expensive new medicines whilst still making efficiency improvements; and addressing medium-term financial sustainability challenges from demographic ageing. World Health
Avila, Rodolfo; Larsson, Carl-Magnus; Prendes, Miguel; Zerquera, Juan Tomas
This project results from the co-operation between a number of Cuban and Swedish institutions. It started in February 2001 and ended in June 2003 and was made possible thanks to the contributions of the Swedish International Development Co-operation Agency (SIDA), the Centro de Proteccion e Higiene de las Radiaciones, Cuba (CPHR), and the Swedish Radiation Protection Authority (SSI). The overall objective was to strengthen the radiation protection system in Cuba, and in this way contribute with the control and reduction of risks to man and the environment from exposures to ionizing radiation. The project focused on four priority areas: 1) Protection of workers and patients exposed to radiation in radiation practices; 2) Preparedness for response to an emergency situation; 3) Environmental radiological protection; and, 4) Exposure to radiation in areas with high levels of natural radioactivity. The present report summarizes the findings of the whole project period, providing an overview of the overall achievements, as well as listing its deliverables. The results of an evaluation of the project, conducted during the final workshop, are also included. The report ends with a list of generic and specific conclusions and recommendations for implementation of the project's achievements and for further development of co-operation.
Williams, Brett; Lynch, Marty; Olaussen, Alex; Lachmann, Hanna; Kalén, Susanne; Ponzer, Sari
Interprofessional education (IPE) is widely accepted worldwide, as a key part of training for health professionals and critical to an effective, patient-centred healthcare system. Several tools have been developed to evaluate IPE programmes and interventions globally. Many of the widely-used tools have been successfully adapted to suit specific cohorts and different languages; the Interdisciplinary Education Perception Scale (IEPS), however, has not yet been translated and validated for use in Sweden. The aim of this study was to translate the IEPS into Swedish and validate the psychometric properties of this new version. The 12-item IEPS underwent translation into Swedish and back-translation into English by suitable independent translators to ensure items retained their meaning. The new Swedish version was completed by 164 medical and nursing, occupational therapy and physiotherapy students on clinical placements in Stockholm. Principal Axis Factoring (PAF) and Oblique Oblimin Rotation confirmed a three-factor structure, that explained 77.4% of variance. The new 10-item Swedish version IEPS displayed good internal consistency with an overall Cronbach's alpha of a = .88 and subscale values of .89, .88 and .66. The exclusion of two-items limits the transferability of this scale; however, the factor makeup was very similar to the original 12-item English version. It is suspected that minor differences were due to unavoidable deviations in meaning following translation (i.e. certain English words have no equivalent in Swedish). Nevertheless, the results imply that the Swedish version of the IEPS is a valid and reliable tool for assessing students' perceptions and attitudes towards IPE within the Swedish health education system.
Pagels, Peter; Wester, Ulf; Söderström, Margareta
More scheduled outdoor stay is increasingly advocated for school children. This study measured 2nd, 5th and 8th graders' erythemal UV-exposure in September, March and May at four Swedish schools. We related those exposures, as fractions of total available ambient radiation, to the schools outdoor......, offer enough shade to protect children from overexposure during seasons with potentially harmful solar UV radiation. Pupils' outdoor stay may be extended during September and March. In May extended outdoor stay of the youngest pupils requires a more UVR-protective environment.......More scheduled outdoor stay is increasingly advocated for school children. This study measured 2nd, 5th and 8th graders' erythemal UV-exposure in September, March and May at four Swedish schools. We related those exposures, as fractions of total available ambient radiation, to the schools outdoor...... environments differing in amount of shade, vegetation, and peripheral city-scape quantified as percentage of free sky view calculated from fish-eye photographs. Exposures correlated with the sky views (with exceptions in May) and were suberythemal. The exposures were also below the threshold limit...
Norström, Lisa; Lindberg, Lene; Månsdotter, Anna
Mental ill-health among children and young adults is a growing public health problem and research into causes involves consideration of family life and gender practice. This study aimed at exploring the association between parents' degree of gender equality in childcare and children's mental ill-health. The population consisted of Swedish parents and their firstborn child in 1988-1989 (N = 118 595 family units) and the statistical method was multiple logistic regression. Gender equality of childcare was indicated by the division of parental leave (1988-1990), and child mental ill-health was indicated by outpatient mental care (2001-2006) and drug prescription (2005-2008), for anxiety and depression. The overall finding was that boys with gender traditional parents (mother dominance in childcare) have lower risk of depression measured by outpatient mental care than boys with gender-equal parents, while girls with gender traditional and gender untraditional parents (father dominance in childcare) have lower risk of anxiety measured by drug prescription than girls with gender-equal parents. This study suggests that unequal parenting regarding early childcare, whether traditional or untraditional, is more beneficial for offspring's mental health than equal parenting. However, further research is required to confirm our findings and to explore the pathways through which increased gender equality may influence child health.
Full Text Available Abstract Introduction Mental ill-health among children and young adults is a growing public health problem and research into causes involves consideration of family life and gender practice. This study aimed at exploring the association between parents' degree of gender equality in childcare and children's mental ill-health. Methods The population consisted of Swedish parents and their firstborn child in 1988-1989 (N = 118 595 family units and the statistical method was multiple logistic regression. Gender equality of childcare was indicated by the division of parental leave (1988-1990, and child mental ill-health was indicated by outpatient mental care (2001-2006 and drug prescription (2005-2008, for anxiety and depression. Results The overall finding was that boys with gender traditional parents (mother dominance in childcare have lower risk of depression measured by outpatient mental care than boys with gender-equal parents, while girls with gender traditional and gender untraditional parents (father dominance in childcare have lower risk of anxiety measured by drug prescription than girls with gender-equal parents. Conclusions This study suggests that unequal parenting regarding early childcare, whether traditional or untraditional, is more beneficial for offspring's mental health than equal parenting. However, further research is required to confirm our findings and to explore the pathways through which increased gender equality may influence child health.
Introduction Mental ill-health among children and young adults is a growing public health problem and research into causes involves consideration of family life and gender practice. This study aimed at exploring the association between parents' degree of gender equality in childcare and children's mental ill-health. Methods The population consisted of Swedish parents and their firstborn child in 1988-1989 (N = 118 595 family units) and the statistical method was multiple logistic regression. Gender equality of childcare was indicated by the division of parental leave (1988-1990), and child mental ill-health was indicated by outpatient mental care (2001-2006) and drug prescription (2005-2008), for anxiety and depression. Results The overall finding was that boys with gender traditional parents (mother dominance in childcare) have lower risk of depression measured by outpatient mental care than boys with gender-equal parents, while girls with gender traditional and gender untraditional parents (father dominance in childcare) have lower risk of anxiety measured by drug prescription than girls with gender-equal parents. Conclusions This study suggests that unequal parenting regarding early childcare, whether traditional or untraditional, is more beneficial for offspring's mental health than equal parenting. However, further research is required to confirm our findings and to explore the pathways through which increased gender equality may influence child health. PMID:22463683
Ahmedov, Mohir; Azimov, Ravshan; Mutalova, Zulkhumor; Huseynov, Shahin; Tsoyi, Elena; Rechel, Bernd
Uzbekistan is a central Asian country that became independent in 1991 with the break-up of the Soviet Union. Since then, it has embarked on several major health reforms covering health care provision, governance and financing, with the aim of improving efficiency while ensuring equitable access. Primary care in rural areas has been changed to a two-tiered system, while specialized polyclinics in urban areas are being transformed into general polyclinics covering all groups of the urban population. Secondary care is financed on the basis of past expenditure and inputs (and increasingly self-financing through user fees), while financing of primary care is increasingly based on capitation. There are also efforts to improve allocative efficiency, with a slowly increasing share of resources devoted to the reformed primary health care system. Health care provision has largely remained in public ownership but nearly half of total health care expenditure comes from private sources, mostly in the form of out-of-pocket expenditure. There is a basic benefits package, which includes primary care, emergency care and care for certain disease and population categories. Yet secondary care and outpatient pharmaceuticals are not included in the benefits package for most of the population, and the reliance on private health expenditure results in inequities and catastrophic expenditure for households. While the share of public expenditure is slowly increasing, financial protection thus remains an area of concern. Quality of care is another area that is receiving increasing attention. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
Lundberg, Veronica; Eriksson, Catharina
This study investigates gender differences in self-reports and between parent and child reports in Health-related Quality of Life (HRQOL), measured with disease-specific and generic instruments for chronic disease. Comparison of HRQOL results in this Juvenile Idiopathic Arthritis (JIA) sample to a European cohort of children with JIA and one of children with other health conditions are also made. Fifty-three children with juvenile idiopathic arthritis (JIA), aged 8-18 years, and their parents completed the condition-specific DISABKIDS for JIA, and the DISABKIDS generic instrument for chronic conditions (DCGM-37) in a cross-sectional study. European reference data were used for comparison of child and parental reports. Child self-reports in DCGM-37 and DISABKIDS for JIA showed no gender differences. Parental and child reports of the child's HRQOL differed only in DCGM-37; this was among girls who scored their independence (p = 0.03), physical limitation (p = 0.01), social exclusion (p = 0.03), emotions (p children with JIA reported more physical limitation compared to samples of European children with JIA (p = 0.01), European children with chronic conditions (p children reported more problem with understanding compared to the European JIA sample (p = 0.03). Swedish parents perceived their children's independence significantly lower than did the European parents of JIA children (p children with chronic conditions (p = 0.03). The Swedish parents also perceived their children to have significantly lower social inclusion (p children with chronic conditions. Parent-child differences in assessment of quality of life depend on the HRQOL instrument used, especially among girls. In comparison to European cohorts, our sample of children with JIA experienced more physical limitations and less understanding.
The shrinking size and weight of electronic circuitry has given rise to a new generation of smart clothing that enables biological data to be measured and transmitted. As the variation in the number and type of deployable devices and sensors increases, technology must allow their seamless integration so they can be electrically powered, operated, and recharged over a digital pathway. Nyx Illuminated Clothing Company has developed a lightweight health monitoring system that integrates medical sensors, electrodes, electrical connections, circuits, and a power supply into a single wearable assembly. The system is comfortable, bendable in three dimensions, durable, waterproof, and washable. The innovation will allow astronaut health monitoring in a variety of real-time scenarios, with data stored in digital memory for later use in a medical database. Potential commercial uses are numerous, as the technology enables medical personnel to noninvasively monitor patient vital signs in a multitude of health care settings and applications.
Bergström, Malin; Fransson, Emma; Hjern, Anders; Köhler, Lennart; Wallby, Thomas
This study compared the psychological symptoms of 129 children in joint physical custody with children in single care and nuclear families, using a nationally representative 2011 survey of 1,297 Swedish children aged between four and 18 years. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) and its association with three dimensions of parental life satisfaction was investigated. Linear regression analyses showed higher SDQ-scores for children in joint physical custody (B = 1.4, p after adjustment for socio-demographic variables. The estimates decreased to 1.1 and 1.3, respectively, after being adjusted for parental life satisfaction ( p Parental life satisfaction should be investigated further as a possible explanation of differences in symptom load between children in different living arrangements. © 2014 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley&Sons Ltd.
major causes of mortality such as malaria and a cluster of childhood illnesses. The teams discovered, however, that to effec- tively address these conditions, it was necessary to increase capacity both at the level of the village clinic and throughout the health system. Subsequently, the teams invested a portion of their modest ...
Casalicchio, Emiliano; Caselli, M.; Coletta, Alessio; Di Blasi, Salvatore; Fovino, Igor Nai; Butts, Jonathan; Shenoi, Sujeet
Modern critical infrastructure assets are exposed to security threats arising from their use of IP networks and the Domain Name System (DNS). This paper focuses on the health of DNS. Indeed, due to the increased reliance on the Internet, the degradation of DNS could have significant consequences for
Džakula, Aleksandar; Sagan, Anna; Pavić, Nika; Lonćčarek, Karmen; Sekelj-Kauzlarić, Katarina
Croatia is a small central European country on the Balkan peninsula, with a population of approximately 4.3 million and a gross domestic product (GDP) of 62% of the European Union (EU) average (expressed in purchasing power parity; PPP) in 2012. On 1 July 2013, Croatia became the 28th Member State of the EU. Life expectancy at birth has been increasing steadily in Croatia (with a small decline in the years following the 1991 to 1995 War of Independence) but is still lower than the EU average. Prevalence of overweight and obesity in the population has increased during recent years and trends in physical inactivity are alarming. The Croatian Health Insurance Fund (CHIF), established in 1993, is the sole insurer in the mandatory health insurance (MHI) system that provides universal health coverage to the whole population. The ownership of secondary health care facilities is distributed between the State and the counties. The financial position of public hospitals is weak and recent reforms were aimed at improving this. The introduction of concessions in 2009 (public private partnerships whereby county governments organize tenders for the provision of specific primary health care services) allowed the counties to play a more active role in the organization, coordination and management of primary health care; most primary care practices have been privatized. The proportion of GDP spent on health by the Croatian government remains relatively low compared to western Europe, as does the per capita health expenditure. Although the share of public expenditure as a proportion of total health expenditure (THE) has been decreasing, at around 82% it is still relatively high, even by European standards. The main source of the CHIFs revenue is compulsory health insurance contributions, accounting for 76% of the total revenues of the CHIF, although only about a third of the population (active workers) is liable to pay full health care contributions. Although the breadth and scope
Marjanovic, Marija; Buhlin, Kåre
To investigate if patients with periodontitis attending the Dental School in Huddinge, Sweden presented with more signs of systemic diseases, such as cardiovascular disease, diabetes mellitus and respiratory diseases, compared to healthy and gingivitis patients. In this retrospective study, dental charts were examined where the periodontal diagnoses of patients were known. A total of 325 patients with severe periodontitis and 149 patients without periodontitis, born 1928 to 1968, were identified. Diagnosis regarding the systemic diseases was self-reported. Odds ratios for cardiovascular diseases, diabetes mellitus and respiratory diseases were calculated with a logistic regression model that was adjusted for age, gender and smoking. It was observed that more cases of periodontitis were found in older individuals than the controls (61.7 vs 56.2 years; P diabetes mellitus. Among the controls, 30.9% had cardiovascular disease, 23.5% suffered from respiratory diseases and 6.7% had diabetes mellitus. Across both groups, hypertension was the most frequent diagnosis. There was a significant association between periodontitis and cardiovascular disease (odds ratio [OR] = 1.79, confidence interval [CI] 1.12-2.86), but not between respiratory diseases and periodontitis (OR= 0.88, CI 0.53-1.47). The risk of diabetes mellitus was greater among those patients with periodontitis (OR= 2.95, CI 1.45- 6.01). This study found that patients with periodontitis presented with more systemic diseases, such as cardiovascular disease and diabetes mellitus than control patients. However, no association was found between periodontitis and respiratory diseases. At the present time, the reasons for the associations or lack of association are unknown.
The main characteristics of ‘the Swedish model’ are arguably related to the country's knowledge-intensive industry and its advanced welfare state. The purpose of this chapter is to discuss the historical development of these two features of the Swedish economy. The first part looks at industrial...
After reforms in pension systems had taken place in most European countries within the last two decades, the concern was raised that women may be disadvantaged by these reforms. It is suggested that they are faced with a higher financial need to work longer. Retrospective data from SHARELIFE are used to run an event history analysis on the timing of the final employment exit, separately for gender, country and exit cohort. This study aims to disentangle the influence of gendered labour markets and pension regulations on retirement timing by investigating conditions in Denmark and Sweden. Some evidence was found that women compensate for lower labour market attachment due to long part-time periods by working longer, especially in younger cohorts. This seems to depend on the pension system. In countries with broad basic pensions, high replacement rates for low-income groups and fewer penalties for early retirement, the compensation is suggested to be less frequent. This study indicates the growing importance of the "compensation hypothesis" compared to the "status maintenance hypothesis" of previous careers in relation with retirement timing.
Full Text Available Organizational resilience emphasizes the adaptive capacity for renewal after crisis. This paper explores the sustainability and resilience of a not-for-profit firm that claims to contribute to sustainable development of the food system. We used semi-structured interviews and Holling’s adaptive cycle as a heuristic device to assess what constitutes social and sustainable entrepreneurship in this case, and we discuss the determinants of organizational resilience. The business, Biodynamiska Produkter (BP, has experienced periods of growth, conservation and rapid decline in demand, followed by periods of re-organization. Our results suggest that BP, with its social mission and focus on organic food, meets the criteria of both a social and sustainability entrepreneurial organization. BP also exhibits criteria for organizational resilience: two major crises in the 1970s and late 1990s were met by re-organization (transformation and novel market innovations (adaptations. BP has promoted the organic food sector in Sweden, but not profited from this. In this case study, resilience has enhanced sustainability in general, but trade-offs were also identified. The emphasis on trust, local identity, social objectives and slow decisions may have impeded both economic performance and new adaptations. Since the successful innovation Ekolådan in 2003, crises have been met by consolidation rather than new innovations.
Consequences of the quota requirement for energy efficiency. Can a Swedish quota obligation systems give less energy usage?; Konsekvenser av kvotplikt foer energieffektivisering. Kan ett svenskt kvotpliktssystem ge mindre energianvaendning?
Bjoerkroth, Sara; Bladh, Mats; Holmberg, Rurik; Lock, Anna; Naderi, Ronak; Widerstroem, Glenn
The Agency has on behalf of the government investigated what the consequences would be of the introduction of a compulsory quota system in Sweden. Under the proposed new EU directive on energy efficiency, all Member States should introduce a compulsory quota system, where energy companies actively initiate measures for energy efficiency among end users. In Sweden, a quota obligation system of this kind would mean energy efficiency of about 3 TWh per year, which can be difficult to achieve. The Swedish Energy Agency suggests that if a compulsory quota system is introduced, the quota obligation should be placed on the network companies. If not, there is a risk of complications in the Swedish and Nordic electricity market. The Energy Markets Inspectorate consider that the quota obligation can not be on the network companies because of their function as regulated monopoly. The Swedish Energy Agency suggests that efficiency measures can be implemented in all sectors, including transport.
Hoppenbrouwers, Sylco S; Neumann, Craig S; Lewis, Jonathan; Johansson, Peter
An influential neurobiological model of personality is the Reinforcement Sensitivity Theory, which postulates how basic motivational systems (behavioral activation system [BAS], behavioral inhibition system [BIS]) can help account for the development and expression of individual differences in personality. Earlier research has documented a link between psychopathic personality and the BIS/BAS scale (Carver & White, 1994), which was developed to measure the behavioral inhibition and activation systems. However, no studies have examined how latent BIS/BAS factors and the 4 empirically derived Psychopathy Checklist-Revised (PCL-R) psychopathy factors (Hare & Neumann, 2008) are associated across different cultures. In the current study, structural equation modeling was used to determine how the 4 PCL-R factors were able to predict BIS/BAS factors using 2 large independent samples of male offenders (North American N = 908; Swedish N = 242). The results were in line with theory and revealed a negative relationship between the PCL-R Affective factor and the BIS factor as well as positive relationships between the PCL-R Antisocial and Lifestyle factors with the BAS factor. Overall, the results of the current study provide evidence of cross-cultural generalizability for the associations between the PCL-R factors and the BIS-BAS factors. Taken together, the PCL-R psychopathy factors were able to account for meaningful variance in the BIS-BAS factors and further support a dimensional approach to understanding the psychopathy construct across cultures. (c) 2015 APA, all rights reserved).
After the introduction of a law prohibiting the start-up of any new nuclear power plant until the utility had shown that the waste produced by the plant could be taken care of in an absolutely safe way, the Swedish nuclear utilities in December 1976 embarked on the Nuclear Fuel Safety Project, which in November 1977 presented a first report, Handling of Spent Nuclear Fuel and Final Storage of Vitrified Waste (KBS-I), and in November 1978 a second report, Handling and Final Storage of Unreprocessed Spent Nuclear Fuel (KBS II). These summary reports were supported by 120 technical reports prepared by 450 experts. The project engaged 70 private and governmental institutions at a total cost of US $15 million. The KBS-I and KBS-II reports are summarized in this document, as are also continued waste research efforts carried out by KBS, SKBF, PRAV, ASEA and other Swedish organizations. The KBS reports describe all steps (except reprocessing) in handling chain from removal from a reactor of spent fuel elements until their radioactive waste products are finally disposed of, in canisters, in an underground granite depository. The KBS concept relies on engineered multibarrier systems in combination with final storage in thoroughly investigated stable geologic formations. This report also briefly describes other activities carried out by the nuclear industry, namely, the construction of a central storage facility for spent fuel elements (to be in operation by 1985), a repository for reactor waste (to be in operation by 1988), and an intermediate storage facility for vitrified high-level waste (to be in operation by 1990). The R and D activities are updated to September 1981.
Istepanian, Robert; Laxminarayan, Swamy; Pattichis, Constantinos S.
M-health can be defined as the "emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria.
Among the increasing number of deals that are creating larger healthcare systems across the country, the Trinity Health and Catholic Health East merger stands out for its size and scope. "In the world we live in, because of reform, we know scale matters, and we do believe that the opportunity that we see translates to synergy," says Joseph Swedish, left, president and CEO of Trinity Health.
Sirintrapun, S Joseph; Artz, David R
This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.
Björk Brämberg, Elisabeth; Torgerson, Jarl; Norman Kjellström, Anna; Welin, Peder; Rusner, Marie
Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be
The Swedish Minister for Higher Education and Research recently visited CERN. The Swedish Minister was greeted by Swedish scientists working at CERN. Signing of the Swedish Computing Memorandum of Understanding. Pär Omling, Director-General of the Swedish Research Council (left), and Jos Engelen, CERN’s Chief Scientific Officer. Lars Leijonborg, the Swedish Minister for Higher Education and Research, was welcomed to CERN by Director-General Robert Aymar on 10 March. After an introduction to the Laboratory’s activities, the Minister was given guided tours of the control room, the ATLAS surface hall and experiment cavern and the adjoining LHC tunnel. Mr Leijonborg was then greeted by Swedish scientists and given an overview of the Swedish research programme at CERN. Five Swedish university groups are taking part in LHC research. Swedish universities are notably involved in the manufacture of parts for the sub-detectors of AT...
US Agency for International Development — The Health Research Information Tracking System (HRIT) is an expansion of the Child Health Research database that collects and maintains categorization, description,...
Aran, Daniel; Laca, Hernán
This paper describes the Uruguayan health system, including its structure and coverage, its financial sources, the level and distribution of its health expenditure, the physical, material and human resources available, its stewardship functions, the institutions in charge of information and research, and the level and type of citizen's participation in the operation and evaluation of the system. The most recent policy innovations are also discussed, including the creation of the National Comprehensive Health System, the National Health Insurance, the National Health Fund and the Comprehensive Health Care Program. Finally, the impact of these innovations in health expenditure, fairness of health financing, coverage levels and main health indicators is analyzed.
Air quality and residential wood combustion - application of the model system SIMAIRrwc for some Swedish municipalities; Luftkvalitet och smaaskalig biobraensleeldning. Tillaempningar av SIMAIRved foer naagra kommuner
Omstedt, Gunnar; Andersson, Stefan; Johansson, Christer; Loefgren, Bengt-Erik
SIMAIRrwc is a Web based evaluation tool for meeting the EU directive on air pollution limits in residential areas using wood combustion. The background is a four-year research program (2001-2004) called Biomass Combustion Health and Environment. Some conclusions from this program were that emissions from small scale wood combustion can influence human health mainly due to high emitting old wood stoves during cold weather conditions and that the air quality in such areas can improve significantly if old wood stoves were replaced by modern wood boilers attached to a storage tank or with a pellet boiler. SIMAIRrwc is based on the same principles as SIMAIRroad, which is a Web based evaluation tool for road traffic i.e. coupled model system using different models on local, urban and regional geographical scales, best available emission data, but at the same time presented in a very simplified way. In this project SIMAIRrwc has been applied in five different Swedish municipalities. The aim has been to apply and improve the model in cooperation with the municipalities. The conclusions from the project are: Small scale wood combustions in residential areas are local problems which sometimes include only a few houses and/or wood-burners. Air quality problems related to the EU directive are mainly due to particles. Combinations of residential areas with wood combustion and emissions from nearby dense traffic roads might give rise to bad air quality. Actions require knowledge about individual equipment which needs information from the local chimney sweeps. The best way to identify problem areas is to use model calculations. If model calculations indicate risks of exceeding air quality limits, then new calculations should be made with improved input data taking into account for example information of district heating or other installations that can effect the emissions. Before actions are taken it may also be useful to make measurements. The measurement site can then be
This study analysed the environmental follow-up of a public organisation from a systems thinking approach, including follow-up within different phases of operation and with different environmental management tools. The Swedish Rail Administration (SRA), a public authority responsible for Swedish rail infrastructure, was used as a case organisation. The main aim was to identify different follow-up activities during planning, construction and operation of rail infrastructure. Additional aims were to identify limiting factors for effective environmental follow-up and to provide suggestions on how SRA follow-up can better be used as an organisational learning tool. The follow-up proved to be highly influenced by Environmental Management System and was mainly used for showing compliance with legal regulations or contract requirements. Use of environmental monitoring data was limited to the specific project in which the follow-up was carried out, possibly because of the project-based structure of the organisation following rail deregulation. Theory on organisational learning was applied in the study to discuss how to improve the distribution and use of follow-up data. A more complete `organisational memory' seems to be required for learning from experience and adapting to change.
Full Text Available Background. Depression and anxiety disorders are major world-wide problems. There are no or few epidemiological studies investigating the prevalence of depression, generalized anxiety disorder and anxiety disorders in general in the Swedish population.Methods. Data were obtained by means of a postal survey administered to 3001 randomly selected adults. After two reminders response rate was 44.3%. Measures of depression and general anxiety were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9 and the 7-item Generalized Anxiety Disorder Scale (GAD-7. The PHQ-9 identified participants who had experienced clinically significant depression (PHQ-9 ≥ 10, and who had a diagnosis of major depression (defined by using a PHQ-9 scoring algorithm. Clinically significant anxiety was defined as having a GAD-7 score ≥ 8. To specifically measure generalized anxiety disorder, the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV was used with an established cut-off. Health-related quality of life was measured using the EuroQol (EQ-5D. Experiences of treatments for psychiatric disorders were also assessed.Results. Around 17.2% (95% CI: 15.1–19.4 of the participants were experiencing clinically significant depression (10.8%; 95% CI: 9.1–12.5 and clinically significant anxiety (14.7%; 95% CI: 12.7–16.6. Among participants with either clinically significant depression or anxiety, nearly 50% had comorbid disorders. The point prevalence of major depression was 5.2% (95% CI: 4.0–6.5, and 8.8% (95% CI: 7.3–10.4 had GAD. Among those with either of these disorders, 28.2% had comorbid depression and GAD. There were, generally, significant gender differences, with more women having a disorder compared to men. Among those with depression or anxiety, only between half and two thirds had any treatment experience. Comorbidity was associated with higher symptom severity and lower health-related quality of life.Conclusions. Epidemiological data
Full Text Available Abstract Background There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort. Methods All pupils in the last year of compulsory school in Luleå in 1981 (n = 1083 form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981 until the age of 43 (in 2008. We created and tested the following composite measures from self-reports at each follow-up: depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time. Results As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions are likely to have acceptable factorial invariance as well as internal consistency over time. Conclusions Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.
UP-report. Fuel-based energy systems. Basis of the Development platform. Fuel to the Swedish Energy Agency's strategy work FOKUS; UP-rapport. Braenslebaserade energisystem. Underlag fraan Utvecklingsplattformen. Braensle till Energimyndighetens strategiarbete FOKUS
The report serves as input to the Swedish Energy Agency's strategies and priorities for research and innovation in the fuel-based energy system for the period 2011 - 2016. The report has been compiled by members of the development platform Fuel. This report provides background and conditions for the fuel based energy system, and proposed priorities and activities for future efforts in this area. The development platform has contributed with valuable experience and knowledge which enabled the Swedish Energy Agency to then develop a strategy that meets the needs of the society and business.
UP-report. The power system. Basis of the Development platform. Power to Swedish Energy Agency's strategy work FOKUS; UP-rapport. Kraftsystemet. Underlag fraan Utvecklingsplattformen. Kraft till Energimyndighetens strategiarbete FOKUS
The report serves as input to to Swedish Energy Agency's strategies and priorities for research and innovation in the power system for the period 2011 - 2016. The report has been compiled by members of the development platform Kraft. This report provides background and circumstances for the power system theme, and proposed priorities and activities for future efforts in this area. The development platform has contributed with valuable experience and skills that enabled the Swedish Energy Agency to then develop a strategy that meets the needs of society and business.
UP-report. Buildings in the energy system. Basis of the Development platform. Build to the Swedish Energy Agency's strategy work FOKUS; UP-rapport. Byggnader i energisystemet. Underlag fraan Utvecklingsplattformen. Bygg till Energimyndighetens strategiarbete FOKUS
The report serves as input to the Swedish Energy Agency's strategies and priorities for research and innovation in the thematic area buildings in the energy system for the period 2011 - 2016. The report has been compiled by members of the development platform Build. This report provides background and the conditions of the area buildings in the energy system, and proposed priorities and activities for future efforts in this area. The development platform has contributed with valuable experience and knowledge which enabled the Swedish Energy Agency to then develop a strategy that meets the needs of the society and business.
Ludvigsson, Jonas F; Otterblad-Olausson, Petra; Pettersson, Birgitta U; Ekbom, Anders
Swedish health care and national health registers are dependent on the presence of a unique identifier. This paper describes the Swedish personal identity number (PIN) and explores ethical issues of its use in medical research. A ten-digit-PIN is maintained by the National Tax Board for all individuals that have resided in Sweden since 1947. Until January 2008, an estimated 75,638 individuals have changed PIN. The most common reasons for change of PIN are incorrect recording of date of birth or sex among immigrants or newborns. Although uncommon, change of sex always leads to change of PIN since the PIN is sex-specific. The most common reasons for re-use of PIN (n = 15,887), is when immigrants are assigned a PIN that has previously been assigned to someone else. This is sometimes necessary since there is a shortage of certain PIN combinations referring to dates of birth in the 1950s and 1960s. Several ethical issues can be raised pro and con the use of PIN in medical research. The Swedish PIN is a useful tool for linkages between medical registers and allows for virtually 100% coverage of the Swedish health care system. We suggest that matching of registers through PIN and matching of national health registers without the explicit approval of the individual patient is to the benefit for both the individual patient and for society.
Strandh, Mattias; Nilsson, Karina; Nordlund, Madelene; Hammarström, Anne
Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43. The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3% of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18-21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42. Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders. Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 (OR = 2.48, CI = 1.57-3.60) as well as at age 43 (OR = 1.71, CI = 1.20-2.43). No such significant relationship is observed for exposure to youth programs at age 21 (OR = 0.95, CI = 0.72-1.26) or at age 43 (OR = 1.23, CI = 0.93-1.63). A considered and consistent active labor
Svensson, Birgitta; Idvall, Ewa; Nilsson, Fredrik; Liuba, Petru
As survival of children with CHD needing surgery has improved significantly, the need for follow-up in terms of health-related quality of life has become increasingly important. In this study, we sought to describe health-related quality of life in children with CHD in relation to cardiac surgery. A retrospective Swedish National Registry for Congenital Heart Disease survey measured using DISABKIDS chronic generic measure-short version included 337 children (age 9-17 years; 39% girls). The majority (n=319, 95%) of children had a biventricular heart, whereas the remaining had a univentricular heart. Cardiac surgery was performed in 197 (58%) children. Health-related quality of life was expressed as total score (100 highest) and given as medians and 10-90th percentiles. The overall total score was 95 (88-100). Children with a biventricular heart who had undergone three or more surgeries (n=31; 9%) had the lowest total score of 81 (61-97; pChildren with two or more surgeries and those with univentricular heart were classified in NYHA II more frequently than children with one or no cardiac surgery (p=0.005 and Children with three or more surgeries and those with univentricular heart needed more help at school (pchildren with other chronic diseases, children with CHD had a high total score except for children with three or more surgeries who had comparable total scores with children with other chronic diseases. Children with three or more cardiac surgeries and those with a univentricular heart appear to have lower health-related quality of life, cognitive ability, and NYHA classification.
Risholm Mothander, Pia; Furmark, Catarina; Neander, Kerstin
This study presents effects of adding Circle of Security-Parenting (COS-P) to an already established comprehensive therapeutic model for early parent-child intervention in three Swedish infant mental health (IMH) clinics. Parents' internal representations and quality of parent-infant interaction were studied in a clinical sample comprised of 52 parent-infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS-P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS-P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS-P group. Improvements in the TAU-group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS-P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS-P in IMH treatment. © 2017 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.
Sundbeck, Mats; Agardh, Anette; Östergren, Per-Olof
The fact that youth take sexual risks when they are abroad have been shown in previous studies. However, it is not known if they increased their sexual risk-taking when travelling abroad, compared to the stay in their homeland. To assess whether Swedish youth increased their individual sexual risk behaviour, defined as having a casual sex partner, when travelling abroad and to examine possible factors that may be associated with increased risk-taking abroad. In 2013, a population-based sample of 2189 Swedes, 18-29 years, was assessed by a questionnaire (45% response rate). Sexuality, duration of travel, parents' country of origin, mental health, heavy episodic drinking (HED), use of illicit drugs, and socio-demographic background were assessed. Increased risk of casual sex in relation to time spent abroad vs. time spent in Sweden was analysed by a variant of case-crossover design. Factors that could be associated with increased risk of casual sex in Sweden and abroad, separately, were analysed by logistic regression.
Andersson, Sven Olof; Brunzell, P.; Heibel, R.; McCarthy, J.; Pennington, C.; Rusch, C.; Varley, G. [NAC International, Zuerich (Switzerland)
In the Encapsulation Station (ES) Review performed by NAC International, a number of different areas have been studied. The main objectives with the review have been to: Perform an independent review of the cost estimates for the ES presented in SKB`s document `Plan 1996`. This has been made through comparisons between the ES and BNFL`s Waste Encapsulation Plant (WEP) at Sellafield as well as with the CLAB facility. Review the location of the ES (at the CLAB site or at the final repository) and its interaction with other parts of the Swedish system for spent fuel management. Review the logistics and plant capacity of the ES. Identify important safety aspects of the ES as a basis for future licensing activities. Based on NAC International`s experience of casks for transport and storage of spent fuel, review the basic design of the copper/steel canister and the transport cask. This review insides design, manufacturing, handling and licensing aspects. Perform an overall comparison between the ES project and the CLAB project with the objective to identify major project risks and discuss their mitigation 19 refs, 9 figs, 35 tabs
Vaez, Marjan; Laflamme, Lucie
...) by self-administered questionnaires. Students' sociodemographic characteristics, their experience of stressors, psychological symptoms, and mental and general health ratings were linked to their academic achievement (degree completed...
Full Text Available Este artículo contrasta dos sistemas educativos, el sueco y el español, por presentar rasgos característicos propios desde los que se explica la consecución de logros diversos. Así, la educación sueca dispone de una estructura administrativa descentralizada que concede un alto nivel de autonomía que llega hasta los municipios y centros, descentralización que ha de convivir con las nuevas medidas recentralizadoras, una alta inversión en materia educativa, una estructura institucional que introduce nuevas medidas de control alejadas del modelo sueco de escuela comprensiva, una creciente polarización en los centros docentes, así como un profesorado a quien se le demanda una formación especializada y exigente, atendiendo al nuevo modelo formativo nacido en 2011. La educación española, por su parte, tampoco parece haber resuelto de manera decidida cuestiones nucleares de índole administrativa y organizativa, aspectos a los que se suman una inversión deficitaria, una integración escolar que parece tambalearse de nuevo, así como un profesorado con frecuencia desmotivado, cuya labor no siempre se reconoce debidamente, y cuya formación también asiste a los vaivenes característicos del sistema. Tiempos convulsos para dos sistemas educativos aquejados de constantes reformas, que confluyen en ciertos cambios de rumbo.This article contrasts two educational systems, Swedish and Spanish, because they show their own characteristic features which explain different achievements. So, Swedish Education has a decentralized administrative structure that grants a high level of autonomy to the municipalities and to the schools, decentralization that lives with the new recentralizing measures, a high investment in education, an institutional structure that introduces new control measures, away from the Swedish comprehensive school model, an emerging polarization in schools and teachers who must have specialized training, in response to the new
The increasingly used concept new public health indicates that a fundamental change has occurred in the goals and methods of disease prevention and health promotion. The change is often said to imply less expert-driven governing of citizens. In this article, governing technologies in the field of public health in Denmark and Sweden are analysed to investigate whether substantial changes have taken place in the governing efforts. In the endeavours unfolded in relation to health examinations for children and pregnant women during the last eighty years, no apparent evidence exists of a significant change in governing technologies. Regulatory, expert-driven and empowering technologies have been used during the whole period; additionally, appeals to autonomy, responsibility and obedience as well as to trust in authorities co-exist throughout the period. The fundamental change is the huge increase in the health authorities' governing ambitions.
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Söderqvist, Fredrik; Carlberg, Michael; Hardell, Lennart
Despite the last years of rapid increase in use of wireless phones little data on the use of these devices has been systematically assessed among young persons. The aim of this descriptive cross-sectional study was to assess use of wireless phones and to study such use in relation to explanatory factors and self-reported health symptoms. A postal questionnaire comprising 8 pages of 27 questions with 75 items in total was sent to 2000 Swedish adolescents aged 15-19 years and selected from the population registry using a stratified sampling scheme. The questionnaire was answered by 63.5% of the study subjects. Most participants reported access to a mobile phone (99.6%) and use increased with age; 55.6% of the 15-year-olds and 82.2% of the 19-year-olds were regular users. Girls generally reported more frequent use than boys. Use of wired hands-free equipment 'anytime' was reported by 17.4%. Cordless phones were used by 81.9%, and 67.3% were regular users. Watching TV increased the odds ratio for use of wireless phones, adjusted for age and gender. Some of the most frequently reported health complaints were tiredness, stress, headache, anxiety, concentration difficulties and sleep disturbances. Regular users of wireless phones had health symptoms more often and reported poorer perceived health than less frequent users. Almost all adolescence in this study used a wireless phone, girls more than boys. The most frequent use was seen among the older adolescents, and those who watched TV extensively. The study further showed that perceived health and certain health symptoms seemed to be related to the use of wireless phones. However, this part of the investigation was explorative and should therefore be interpreted with caution since bias and chance findings due to multiple testing might have influenced the results. Potentially this study will stimulate more sophisticated studies that may also investigate directions of associations and whether, or to what degree, any
Full Text Available Abstract Background Despite the last years of rapid increase in use of wireless phones little data on the use of these devices has been systematically assessed among young persons. The aim of this descriptive cross-sectional study was to assess use of wireless phones and to study such use in relation to explanatory factors and self-reported health symptoms. Methods A postal questionnaire comprising 8 pages of 27 questions with 75 items in total was sent to 2000 Swedish adolescents aged 15–19 years and selected from the population registry using a stratified sampling scheme. Results The questionnaire was answered by 63.5% of the study subjects. Most participants reported access to a mobile phone (99.6% and use increased with age; 55.6% of the 15-year-olds and 82.2% of the 19-year-olds were regular users. Girls generally reported more frequent use than boys. Use of wired hands-free equipment 'anytime' was reported by 17.4%. Cordless phones were used by 81.9%, and 67.3% were regular users. Watching TV increased the odds ratio for use of wireless phones, adjusted for age and gender. Some of the most frequently reported health complaints were tiredness, stress, headache, anxiety, concentration difficulties and sleep disturbances. Regular users of wireless phones had health symptoms more often and reported poorer perceived health than less frequent users. Conclusion Almost all adolescence in this study used a wireless phone, girls more than boys. The most frequent use was seen among the older adolescents, and those who watched TV extensively. The study further showed that perceived health and certain health symptoms seemed to be related to the use of wireless phones. However, this part of the investigation was explorative and should therefore be interpreted with caution since bias and chance findings due to multiple testing might have influenced the results. Potentially this study will stimulate more sophisticated studies that may also investigate
Gómez Dantés, Octavio; Sesma, Sergio; Becerril, Victor M; Knaul, Felicia M; Arreola, Héctor; Frenk, Julio
This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women...
Oudin, Anna; Bråbäck, Lennart; Oudin Åström, Daniel; Forsberg, Bertil
It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO₂ from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m -3 increase in NO₂. The association only seemed to be present in areas where NO₂ was higher than 15 µg·m -3 with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.
(email@example.com), Dictionary Staff of the Swedish Academy,. Lund, Sweden. Abstract: The Swedish Academy Dictionary is one of the world's largest dictionary projects. Work on it was started in 1884 and it will be completed by 2017. The dictionary describes the writ- ten standard language of Swedish from ...
Full Text Available 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.Repeated interviews with ten young men in a cohort of school leavers were analyzed with qualitative content analysis.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.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.
Gard, Gunvor; Larsson, Agneta
Today, we can see a trend toward increased psychosocial strain at work among home-care managers and staff. The aim of this study is to describe home care managers' views on their own psychosocial working conditions and on how to promote workplace health and safety in a municipality in northern Sweden. A mixed-methods design was used, including questionnaire and qualitative focus group data. The qualitative data were analyzed by manifest content analysis. The results indicate that most managers perceived increased variety in work and opportunities for development at work, but at the same time increased demands. The managers suggested that workplace health and safety could be improved by risk assessment and improved communication, a clear communication chain by a real as well as a virtual platform for communication. In summary, workplace health and safety could be improved by risk assessments and by a physical as well as a virtual platform for communication.
Ridell, Karin; Borgström, Margareta; Lager, Elisabeth; Magnusson, Gunilla; Brogårdh-Roth, Susanne; Matsson, Lars
This study evaluated oral health-related quality-of-life (OHRQoL) in children and families before and after dental treatment under general anesthesia because of severe caries or molar-incisor hypomineralization (MIH). A consecutive sample of the parents/caregivers of children (3-14 years) in need of treatment under general anesthesia participated in the study. The children were divided into two groups: 3-6 years and 7-14 years. The 49-item questionnaire that was administered before and after general anesthesia comprised the Child Oral Health Quality of Life-components of the Parental-Caregivers Perception Questionnaire (P-CPQ), the Family Impact Scale (FIS) and two global questions concerning oral health and general well-being. The P-CPQ domains were Oral symptoms, Functional limitations, Emotional well-being and Social well-being. The FIS items assessed impact on family life. In both age groups, a significant decrease (p caries or MIH, performed under general anesthesia, had an immediate effect on the oral health-related quality-of-life in the children in this study and a positive impact on the family situation.
Bränström, Richard; Duncan, Larissa G; Moskowitz, Judith Tedlie
There is increasing recognition of the links between mindfulness, decreased stress, and healthier psychological functioning. However, the majority of this research has been conducted in US samples and the mechanisms through which mindfulness decreases stress and increases well-being are not well understood. The aim of this study was to examine the relations between mindfulness and psychological functioning in a general population sample in Sweden. This cross-sectional study examined the association of mindfulness and five subscales of mindfulness with depression, anxiety, positive states of mind (PSOM), and perceived health. In the spring of 2007, a random population-based sample of N= 1,000 individuals aged 18-60 years in Sweden was contacted by mail with a request to participate in the study. Mindfulness and some of its subscales, in particular Acting with awareness and Non-reactivity to inner experiences, were strongly related to PSOM and perceived health, and inversely related to depression and anxiety. Tests of the moderating role of mindfulness showed that the associations of perceived stress with depression and perceived health were diminished for those with higher levels of mindfulness. Mindfulness is strongly related to well-being and perceived health. Results suggest that dispositional mindfulness might buffer against the negative influence of perceived stress on psychological well-being. These findings give additional support for the use of mindfulness training as a way of improving psychological functioning among people experiencing stress. ©2010 The British Psychological Society.
Döring, Nora; Hansson, Lena M; Andersson, Elina Scheers; Bohman, Benjamin; Westin, Maria; Magnusson, Margaretha; Larsson, Christel; Sundblom, Elinor; Willmer, Mikaela; Blennow, Margareta; Heitmann, Berit L; Forsberg, Lars; Wallin, Sanna; Tynelius, Per; Ghaderi, Ata; Rasmussen, Finn
Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The
Jansson, Sven-Arne; Heibert-Arnlind, Marianne; Middelveld, Roelinde Jm; Bengtsson, Ulf J; Sundqvist, Ann-Charlotte; Kallström-Bengtsson, Ingrid; Marklund, Birgitta; Rentzos, Georgios; Åkerström, Johanna; Östblom, Eva; Dahlén, Sven-Erik; Ahlstedt, Staffan
Our aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow's milk, hen's egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed. The disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years). The domain with the most negative impact on HRQL was AADR, assessing the patients' experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies. The FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic
Josse-Eklund, Anna; Wilde-Larsson, Bodil; Petzäll, Kerstin; Sandin-Bojö, Ann-Kristin
The aim of this study was to describe and explore individual and organisational factors potentially influencing registered nurses' (RNs) attitudes towards patient advocacy. In a quantitative cross-sectional study, data were collected from 226 RNs in community health care of elders. A questionnaire was used to measure a number of factors including attitudes towards patient advocacy, nursing competence, personality traits, individual preferences regarding the quality of health care and working climate. A multiple regression analysis was performed. The results showed that individual factors of nursing competence and individual preferences of the quality of health care, as well as organisational factors of the working climate, explained 26.2% of the variance in the RNs' attitudes towards patient advocacy. Although the mentioned individual factors may be intertwined, the conclusion is that both individual and organisational factors influenced RNs' attitudes towards patient advocacy. The results do not verify that nursing experience, workplace experience, educational level or personality traits influence the RNs' attitudes towards patient advocacy. The proportion of explained variance indicates that additional factors also influence attitudes towards patient advocacy, and more research is needed to shed further light on these factors. © 2013 Nordic College of Caring Science.
Full Text Available Abstract Background Over the past decade, practitioners in primary health care (PHC settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR scheme implemented in a routine PHC setting in Östergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries. Methods Prospective prescription data were obtained for 90% of the primary health care centres in Östergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff. Results During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45–64 years. Half of the patients (50.8% who received PARs were recommended a home-based activity, such as walking. One third (33% of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1–2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38% and nurses (31%. Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1% and overweight (35.4%, followed by high blood pressure (23.3% and diabetes (23.2%. Conclusion Östergötland County's PAR scheme reached a
Nordhaus, W.D. [Yale Univ. (United States)
A phaseout of nuclear power in Sweden is supposed to be accomplished by year 2010. This study is an economic analysis of the questions that are parts of the nuclear dilemma. Even though the economic questions are in focus, the important environmental, health and safety questions are also treated. The basic argument is that Sweden should choose an energy system that allows its citizens to maximize their consumption in a long-term perspective. Consumption is here given a meaning that includes elements outside the market, such as environmental, health and safety aspects valued in a reasonable way. Considerations must also be given to international aspects like global environment, a free and open system of trade and the value of a stable set of rules and proprietary rights. The study compares the economic pros and cons of different energy systems within this general frame. A detailed model of the Swedish energy and power sectors was developed for the study, called the Swedish Energy and Environment Policy (SEEP) model. the SEEP model is built on modern economic theory and includes energy and environmental factors in a uniform way. 8 figs 16 tabs.
Boman, Ase; Borup, Ina; Povlsen, Lene; Dahlborg-Lyckhage, Elisabeth
The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
Nörby, Ulrika; Källén, Karin; Shemeikka, Tero; Korkmaz, Seher; Winbladh, Birger
Pregnant women often have questions concerning fetal effects of drugs but there is limited reliable information specifically intended for them. This study investigated how pregnant women perceive and value the scientific resource Drugs and Birth Defects (www.janusinfo.se/fosterpaverkan) and compared their opinions with those of health care professionals. Electronic questionnaire study. Pregnant women were recruited at their regular visits, and health care professionals via e-mail, at 10 antenatal clinics. Altogether, 275 pregnant women, 38 midwives and 30 physicians participated. Among the pregnant women, 81% found the information valuable, 70% that it was easy to understand, and 92% that it strengthened information from the staff. Concerning anxiety for negative fetal effects, 68% of the women answered that the anxiety decreased or was not influenced by the texts and 22% that it increased. Among physicians and midwives, 44% saw risks associated with pregnant women reading the texts and 24% answered that they would fully recommend them to use the database. The corresponding figures among pregnant women were 17 and 65%, respectively (P < 0.001). The professionals preferred, to a greater extent than pregnant women did, lay people to use a special edition. The majority of pregnant women seem to benefit from using a scientific resource on fetal impact of drugs intended for health care professionals. Some women are more worried after having read the information, but most of them still find it valuable. It is important that pregnant women who use the database can reach a medical professional to discuss the contents. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.
Full Text Available Abstract Background Stability or changes of health behaviours have not been studied in association with incidence of disability pension (DP. The aims were to (1 investigate if stability or changes in health behaviours predict DP due to musculoskeletal diagnosis (MSD, (2 to evaluate if an association exists for DP in general, and (3 after taking familial confounding into account. Methods The study sample was 16,713 like-sexed twin individuals born in Sweden between 1935-1958 (6195 complete twin pairs who had participated in two surveys 25 years apart, were alive, and not pensioned at the time of the latest survey. Cox proportional hazards analysis was used to assess the associations (hazard ratios (HR with 95% confidence intervals (CI between stability and change in health behaviours (physical activity, tobacco and alcohol use, body mass index (BMI, and number of pain locations collected at two time points 25 years apart and the incidence of DP until 2008. Results During the follow-up, 1843 (11% individuals were granted DP with 747 of these due to MSD. A higher proportion of women were granted DP than men. Increase in BMI and stable use of tobacco products were predictors for DP due to MSD (HR 1.21-1.48 and DP in general (HR 1.10-1.41. The stability in the frequency of physical activity and increased frequency of physical activity were protective factors for DP due to MSD only when accounting for familial confounding. However, the number of pain locations (stability, increase, or decrease was the strongest predictor for future DP due to MSD (HR 3.69, CI 2.99-4.56 and DP in general (HR 2.15, CI 1.92-2.42. In discordant pair analysis, the HRs for pain were lower, indicating potential familial confounding. Conclusions Health behaviours in adulthood, including an increase in pain locations were associated with the incidence of DP. The association between physical activity and DP was especially related to adulthood choices or habits, i.e., the
Billinton, Roy; Fotuhi-Firuzabad, Mahmud; Aboreshaid, Saleh
This paper presents a technique which combines both probabilistic indices and deterministic criteria to reflect the well-being of a power system. This technique permits power system planners, engineers and operators to maximize the probability of healthy operation as well as minimizing the probability of risky operation. The concept of system well-being is illustrated in this paper by application to the areas of operating reserve assessment and composite power system security evaluation.
Full Text Available Today, the household sector in the European Union and in Sweden accounts for approximately 25% and 22% of the final energy demand, respectively, and the sector will continue to grow in the next decades. To limit the impact on the energy demand of buildings, the European Union has introduced the Energy Performance of Building Directive. In Sweden, a proposal for building regulations adapted to the Energy Performance of Buildings Directive has been released, but no decision on implementation of it has been made. In this article, a real building is simulated to evaluate how different combinations of heating and decentralized energy generation systems are affecting the specific energy demand of the building. Also, an analysis on how the Swedish incentive schemes affect the choice of decentralized energy generation systems is conducted. Furthermore, it is investigated if it is necessary to adopt the incentive schemes to steer towards systems that reduce the specific energy demand of the building. The conclusion in this article is that the current incentive system is ineffective in terms of specific energy demand reduction of buildings. It needs to be adapted so it steers towards a reduction of the specific energy demand of buildings.
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Espejo, R. [Syncho, Solihull (United Kingdom); Gill, A. [Syncho, Oxon (United Kingdom)
The purpose of this report is to share and summarize our findings about the regulatory roles of SKI/SSI in the context of the Swedish Nuclear System (SNS), with an emphasis on nuclear waste management. The driving force in this review is to make decision processes more transparent. What is reported is based on interviews conducted with employees at SKI/SSI/SKB during early December 1996, the presentation to SKI/SSI in January 1997, discussions during the Shap Wells meeting in Cumbria during March 1997 and RISCOM internal discussions. We offer two hypotheses about the way the Nuclear Waste Management System (NWMS) appears to work. We choose one and derive from it a view about structural issues in SNS and NWMS. The conclusion is a set of systemic roles for the regulators. It is the comparison between these systemic roles and the actual situation that may trigger some adjustments in the system. Our hope is that these findings will make apparent feasible and desirable changes in the system in order to increase the chances for transparent decisions in the Nuclear Waste Management System. In summary, Section 2 includes a general background of the NWMS based on interviews and general information. Section 3 makes a more focused attempt to work out the issues expressed by people in the interviews. Section 4 discusses at a more conceptual level systemic ideas such as the unfolding of complexity. Section 5 is an attempt to organize viewpoints about the NWMS and offers hypotheses to support a preliminary diagnosis of the system in Section 6. We call this section `A problem of identity`. It is only in Section 7 that basic systemic arguments are unfolded with the intention of supporting an appreciation of SKI/SSI`s regulatory roles in the nuclear industry as a whole and nuclear waste management in particular. Section 8 offers a summary of conclusions.
Lindegård, A; Larsman, P; Hadzibajramovic, E; Ahlborg, G
To evaluate the influence of perceived stress and musculoskeletal ache/pain, separately and in combination, at baseline, on self-rated work ability and work performance at two-year follow-up. Survey data were collected with a 2-year interval. Health care workers participating at both waves were included. Inclusion criteria were good self-reported work ability and unchanged self-rated work performance at baseline, resulting in 770 participants; 617 women and 153 men. Musculoskeletal pain was assessed using the question "How often do you experience pain in joints and muscles, including the neck and low back?", perceived stress with a modified version of a single item from the QPS-Nordic questionnaire, work performance by the question "Have your work performance changed during the preceding 12 months?" and work ability by a single item from the work ability index. Associations between baseline data and the two outcomes at follow-up were analysed by means of the log binomial model and expressed as risk ratios (RR) with 95% confidence intervals (CI). A combination of frequent musculoskeletal pain and perceived stress constituted the highest risk for reporting decreased work performance (RR 1.7; CI 1.28-2.32) and reduced work ability (RR 1.7; CI 1.27-2.30) at follow-up. Separately, frequent pain, but not stress, was clearly associated with both outcomes. The results imply that proactive workplace interventions in order to maintain high work performance and good work ability should include measures to promote musculoskeletal well-being for the employees and measures, both individual and organizational, to minimize the risk of persistent stress reactions.
In Sweden, all herds detected with salmonella are put under restrictions and measures aiming at eradication are required. The purpose of these studies was to provide a basis for decisions on how surveillance and control of salmonella in Swedish cattle can be made more cost-efficient. Results from a bulk milk screening were used to investigate seroprevalence of salmonella and to study associations between salmonella status and geographical location, local animal density, number of test pos...
The organization of the Swedish electricity market has been in a state of continual change since the electricity market reform was started in the early 1990s. The conditions for the development of the electricity market have changed since the new Electricity Act came into force on 1 January 1996. The purpose of the reform is to introduce greater competition on the electricity market and provide the consumers with greater freedom of choice and, by open trade in electricity, to create the conditions for more efficient pricing. Being the central energy authority, the Swedish National Board for Industrial and Technical Development, NUTEK, was entrusted by the Government with the task of following developments on the Swedish electricity market. The Network Authority, which has the supervisory function for the new electricity market, were entrusted by the Government with the task of following developments on the Swedish electricity market and regularly compiling and reporting current market information. The new electricity market has now been operative for ten months. The Network Authority has submitted to the Government a detailed report entitled `Developments on the electricity market`, dealing with the experience gained from the electricity market reform. The purpose of the publication is to provide the players on the electricity market - the decision makers, the media and the general public - with comprehensive and easily accessible information on the market conditions. The publication includes summaries of information on electricity production and use in recent years, the structure of the electricity market from the perspective of a player, electricity trade in Sweden and in northern Europe, electricity prices in Sweden and other countries, and the impact of the electricity sector on the environment
Family policy remains one of the leading issues of Swedish domestic politics. All parties are agreed that families with children must be given a better deal in the wake of the economic crisis. But how is this to be done and how quickly can it be achieved? Is the expansion of day nursery facilities to be speeded up, or are parents to be given a…
Jönsson, Mattias; Tondel, Martin; Isaksson, Mats; Finck, Robert; Wålinder, Robert; Mamour, Afrah; Rääf, Christopher
In connection with the Chernobyl fallout and the subsequent deposition of radionuclides in Sweden, Swedish municipalities launched a measurement program to monitor the external radiation exposure. This program encompasses measurements of the ambient dose equivalent rate 1 m above ground at selected locations, and repeats those measurements at the same locations at 7-month intervals. Measurement data compiled from the seven locations with the highest deposition were combined with data from aerial surveys since May 1986 of ground deposition of (137)Cs, high-resolution gamma spectrometry performed at four locations in May 1986, and measurements from fixed continuous air gamma rate monitoring stations from 28 April to 15 May 1986. Based on these datasets, a model of the time pattern of the external dose rate in terms of ambient dose equivalent rate from the Chernobyl fallout was developed. The decrease in the ambient dose equivalent rate could, on average, be described by a four-component exponential decay function with effective half-times of 6.8 ± 0.3 d, 104 ± 26 d, 1.0 ± 0.02 y and 5.5 ± 0.09 y, respectively. The predominant contributions to the external dose rate in the first month were from short-lived fission products superseded by (134)Cs and then (137)Cs. Integrated over 70 y and using extrapolation of the curve fits, our model predicts that (137)Cs contributes about 60% and (134)Cs contributes about 30% of the external effective dose at these seven locations. The projected time-integrated 70 y external effective dose to an unshielded person from all nuclides per unit total activity deposition of (137)Cs is estimated to be 0.29 ± 0.0.08 mSv/(kBq m(-2)). These results are in agreement with those found in Chernobyl contaminated Russian forest areas, and emphasize the usefulness of maintaining a long-term and regular measurement program in contaminated areas. Copyright © 2017 Elsevier Ltd. All rights reserved.
Jones, Valerie M.; Graziosi, Barbara
Changes in the age distribution of the population and increased prevalence of chronic illnesses, together with a shortage of health professionals and other resources, will increasingly challenge the ability of national healthcare systems to meet rising demand for services. Large-scale use of eHealth
National Aeronautics and Space Administration — The objective of this proposal is to demonstrate the feasibility of producing a wearable health monitoring system for the human body that is functional, comfortable,...
Hanlin, Rebecca; Andersen, Margrethe Holm
The Global Network for the Economics of Learning, Innovation, and Competence Building Systems (Globelics) is an open and diverse community of scholars working on innovation and competence building in the context of economic development. The major purpose of the network is to contribute to buildin...
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Contemporary use of ticagrelor in patients with acute coronary syndrome : insights from Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)
Sahlen, Anders; Varenhorst, Christoph; Lagerqvist, Bo; Renlund, Henrik; Wallentin, Lars; James, Stefan K.; Jernberg, Tomas
The platelet inhibitor ticagrelor is strongly recommended during 12 months post-acute coronary syndrome (ACS) in European guidelines. We analysed clinical characteristics of patients given ticagrelor for ACS in the real world. We studied the use of ticagrelor in patients admitted for ACS in Sweden between 1 January 2012 and 31 December 2013 who were enrolled in the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended The...
Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems
Igl, Wilmar; Johansson, Asa; Gyllensten, Ulf
Health care and research in rural populations are often limited due to poor infrastructure and small sample sizes. However, such populations have a need for medical care and can be of great value when studying the health effects of lifestyle and genetic factors. The Northern Sweden Population Health Study (NSPHS) is a paradigmatic study that combines a survey of the health status and specific needs of the community with basic research into the environmental and genetic determinants of non-communicable diseases. This article presents the NSPHS results on lifestyle, subclinical, and clinical measures and gives a review of the past contributions of this study to our understanding of the genetic determinants of disease in international collaborations. A population-representative, cross-sectional sample (n=656) was examined from the Karesuando parish in Northern Sweden north of the Arctic Circle. The population consists of individuals living a traditional, subsistence-based lifestyle (TLS, n=96), mainly based on reindeer herding, hunting and fishing, and others following a modern, more industrialized lifestyle (MLS, n=560), similar to other western European countries. Subgroups with a modern versus traditional lifestyle were compared separately in men and women, highlighting differences in lifestyle (eg diet, physical activity), subclinical (eg blood circulation, blood lipids, lung function) and clinical measures (eg disorders of the cardiovascular, metabolic, and musculoskeletal system). TLS men and women consumed much more game meat (Men: 71 vs 194 g/day, p=0.0011; Women: 56 vs 140 g/day, p=0.0020) and less non-game meat (Men: 88 vs 42 g/day, p=1.4x10(-7); Women: 81 vs 42 g/day, p=0.026) compared with the respective MLS group. TLS men consumed less milk (p=4.2x10(-4)), and TLS women less vegetables (p=0.042). TLS men reported more physical activity at work (p=0.042) and TLS women less physical activity at leisure (p=0.0023). Total cholesterol (Men: 220 vs 244 mg/dl, p
Tavallali, Azar G; Kabir, Zarina Nahar; Jirwe, Maria
Sweden has a population of a little more than 9.4 million. The rapid growth of immigration in Sweden has resulted in an increased number of minority ethnic patients and minority ethnic nurses in the Swedish healthcare system. This also applies to paediatric care. The purpose of this study was to explore how parents with ethnic Swedish backgrounds experience minority ethnic nurses' cultural competence and the care the nurses provide in a Swedish paediatric care context. This exploratory qualitative study is of 14 parents with an ethnic Swedish background whose child was in a ward at a children's hospital in Stockholm County Council. Data were collected using semi-structured interviews to identify parents' perceptions and experiences of minority ethnic nurses' cultural competence. The interviews were analysed by qualitative content analysis. The analyses of the interviews led to four main categories: influence of nurses' ethnicity; significance of cross-cultural communication; cross-cultural skills; and the importance of nursing education. Nurses' ethnicity did not have much impact on parents' satisfaction with their child's care. The parents attached importance to nurses' language skills and to their adaptation and awareness of Swedish culture. They also attached weight to nurses' professional knowledge and personal attributes. The role of nursing education to increase nurses' cultural awareness was highlighted too. © 2013 Nordic College of Caring Science.
Högberg, Torbjörn; Magnusson, Annabella; Lützén, Kim; Ewalds-Kvist, Béatrice
Negative and stigmatizing attitudes towards persons with mental illness must be dealt with to facilitate the sufferers' social acceptance. The present study aimed at survey Swedish attitudes towards persons with mental illness related to factors impacting these attitudes. New CAMI-S based on the questionnaire "Community Attitudes to Mental Illness in Sweden" ([CAMI] Taylor & Dear, 1981) was developed with nine behavioral-intention items and thus comprised a total of 29 items. Of 5000 Swedish people, 2391 agreed to complete the questionnaire. Principal component analysis rendered four factors reflecting attitudes towards the mentally ill: Intention to Interact, Fearful and Avoidant, Open-minded and Pro-Integration, as well as Community Mental Health Ideology. The factors were analyzed for trends in attitudes. By MANOVA, the experience of mental illness effects on mind-set towards the sufferers was assessed. By means of logistic regression, demographic factors contributing to positive attitudes towards persons with mental illness residing in the neighborhood were assessed. By New CAMI-S, the Swedish attitudes towards the mentally ill were surveyed and trends in agreement with living next to a person with mental illness were revealed in three out of four factors derived by principal component analysis. Aspects impacting the Swedish attitudes towards persons with mental illness and willingness to have him/her residing in the neighborhood comprised experience of mental illness, female gender, age (31-50 years), born in Scandinavia or outside Europe, only 9 years of compulsory school and accommodation in flat. The New CAMI-S came out as a useful tool to screen Swedish attitudes towards persons with mental illness. Most Swedes were prepared to live next to the mentally ill.
Full Text Available Swedish crime novel has been transforming for many years to become more socially involved. The ambition of many writers is not only to entertain the readers but also to participating in the social debate, criticizing the political and economical system, focusing on important issues such as violence against women, exploitation of working class by the privileged ruling class, the problems of a modern family and the situation of immigrants. Since the moment when in the mid 60’s two journalists Maj Sjöwall and Per Wahlöö decided to use popular literature to spread social matters many other Swedish writers have decided to follow their way. Some of them are journalists – like Liza Marklund, Börge Hellström and Anders Roslund or Stieg Larsson. Their novels as well as the ones written by Henning Mannkel on Kurt Wallander have become crucial evidence of changes of Swedish society in the past twenty years. Modern Swedish crime fiction illustrates the population in the model fashion that is the reason why it can become one of the interests of the sociology of literature.
Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L
People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.
Erceg, Marijan; Stevanović, Ranko; Babić-Erceg, Andrea
Information production and its communication being a key public health activity, developing modern information systems is a precondition for its fulfilling these assignments. A national public health information system (NPHIS) is a set of human resources combined with computing and communication technologies. It enables data linkage and data coverage as well as undertaking information production and dissemination in an effective, standardized and safe way. The Croatian Institute of Public Health LAN/WAN modules are under development. Health Safety System, Health Workers Registry, and Digital Library are among the Institute's developmental priorities. Communication between NPHIS participants would unfold over the Internet by using every relevant data protection method. Web technology-based applications would be run on special servers. Between individual applications, use would be made of the transaction module of communication through an exchange of the HL7 standard-based xml messages. In the conditions of transition, the health system must make an optimal use of the resources, which is not feasible without applying modern information and communication technologies.
Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.
Kaminsky, Elenor; Carlsson, Marianne; Holmström, Inger K; Larsson, Jan; Fredriksson, Mio
Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD. The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis. The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given. The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.
Since 1996, all Swedish public authorities, which includes most universities, have been made responsible for contributing to the sustainable development of the society. Swedish universities are thus required to submit annual environmental reports about their policies, structures and actions. This study provides a review of the activities that…
José Patrício Bispo Júnior
Full Text Available The current article make a discussion with the mains features of the Health Service System and relate the brazilian health system with three mains kinds of Health Service System. Make a concept and a difference between the Health System and the Health Services System. Present the objectives, components, characteristics and functions about the Health Services System. Present and make a discussion about the three mains kinds of Health Serveces System: the Dominance Market of the Health System, the Obrigatory Insurance Health System and the Dominance System of Health. Present the Brazilian Health System as not the unique system, but as a shared system compoud the Unique Health System, the Supplementary Medical Attention System and the Straight Disbursement System. And finaly, argue the relationships for the Brazilian Health System with the three mains Health Services Systems.
Montekio, Víctor Becerril; Medina, Guadalupe; Aquino, Rosana
This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.
Fiedler, Frank; Bales, Chris; Thür, Alexander
partners a system concept has been developed that is characterized by its high compactness and flexibility. It allows the use of different types of boilers, heating distribution systems and a variable store and collector size. Two prototypes have been built, one for the Danish market with a gas boiler......At the beginning of 2003 the four year long research project REBUS on education, research, development and demonstration of competitive solar combisystems was launched. Research groups in Norway, Denmark, Sweden and Latvia are working together with partners from industry on innovative solutions...... for solar heating in the Nordic countries. Existing system concepts have been analyzed and based on the results new system designs have been developed. The proposed solutions have to fulfill country specific technical, sociological and cost requirements. Due to the similar demands on the systems in Denmark...
Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi
In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...
Farrokhnia, Nasim; Göransson, Katarina E
In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray. There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.
Härenstam, Karin Pukk; Elg, Mattias; Svensson, Carina; Brommels, Mats; Ovretveit, John
The purpose of this paper is to survey Swedish healthcare leaders' patient safety awareness, the priority they give to safety issues and their views on suitable safety management strategies. A total 623 leaders of a sample of 1,129 responded to a mail questionnaire (55 percent response rate). Descriptive statistics of the responses are presented as frequency distributions across respondent subgroups. Means were tested for similarity by a repetitive one-way ANOVA procedure. Homogeneous response groups were sought by hierarchical cluster analysis. Swedish healthcare leaders show relatively high safety awareness and how their organizations prioritize safety management. There is a marked polarization between leaders; half feel that the system works reasonably well, and that adequate funds are available to improve or maintain services. The other half thinks the system needs major change and calls for additional funding. A majority sees system errors as the main cause for adverse events; a substantial minority find human errors to be more important. Two-thirds were willing to make safety performance information on organizations and specialties public, one third was restrictive. Survey instruments used to explore leaders' patient safety views have not yet been rigorously tested against psychometric criteria. One hospital type was slightly over-represented and three regions somewhat under-represented in the respondent groups. This is the first systematic attempt to explore the views of Swedish healthcare leaders on patient safety. It provides input to a national strategy to improve patient safety.
Jonsdottir, Ingibjörg H; Rödjer, Lars; Hadzibajramovic, Emina; Börjesson, Mats; Ahlborg, Gunnar
This study analyzes longitudinal associations between self-reported leisure-time physical activity (PA) and perceived stress, burnout and symptoms of depression and anxiety. Cohort data collected in 2004 and 2006 from health care and social insurance workers in western Sweden (2694 women; 420 men) were analyzed. Cox regression was conducted to examine associations between baseline levels of PA and mental health (MH) problems 2 years later. Cross-sectional analysis show that individuals reporting either light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) were less likely to report high levels of perceived stress, burnout and symptoms of depression and anxiety, as compared to individuals reporting a sedentary lifestyle. The risks of symptoms of depression, burnout, and high stress levels at follow-up were significantly lower for those reporting LPA or MVPA at baseline. For symptoms of anxiety, an activity level corresponding to MVPA was required. Participation in PA appeared to lower the risk of developing MH problems two years later. This relationship involved LPA and MVPA regarding feelings of depression, burnout and perceived stress, and exclusively MVPA regarding feelings of anxiety. The implications of these findings are important, as preventive strategies for psychosocial stress and mental health problems are needed. Copyright © 2010 Elsevier Inc. All rights reserved.
Brännström, K Jonas; Båsjö, Sara; Larsson, Josefina; Lood, Sofie; Lundå, Stefan; Notsten, Margareta; Taheri, Satu Turunen
The study examined the self-reported psychosocial work environment for audiologists working in three practice types (public, completely private, and private but publicly funded). A cross-sectional e-mail survey using the demand-control-support questionnaire, a short version of the effort-reward imbalance (ERI) questionnaire, and descriptive data. Five-hundred Swedish licensed audiologists. Overall, the results indicate differences in psychosocial work environment pertaining to the practice types. These differences are small and the type explains few percent of the variability accounted in the measures of psychosocial work environment. Social support seems important for the psychosocial work environment and is considered a reward in itself. Using the demand-control model, 29% of the audiologists reported working in a high-stress psychosocial work environment. Using the ERI-ratio to estimate the imbalance between effort and reward it was shown that that 86% of the participants experienced an unfavorable work situation where the rewards do not correspond to the efforts made. The organizational framework has minor effect on self-reported psychosocial work environment for Swedish licensed audiologists. The percentage of unfavorable ERI-ratios seen in Swedish audiologists seems conspicuously high compared to other working populations in general, but also compared to other health service workers.
Olesen, C; Sorensen, HT; de Jong-van den Berg, L; Olsen, J; Steffensen, FH
Aim. To assess the current prescribing pattern for 15,756 primiparae before, during, and after their pregnancies with reference to fetal and neonatal risk. Method. A prescription database study with linkage to The Danish Medical Birth Registry from 1991 to 1996. The drug subsidy system in Danish
Heinz, Jana; Enghag, Margareta; Stuchlikova, Iva; Cakmakci, Gultekin; Peleg, Ran; Baram-Tsabari, Ayelet
This empirical study investigates factors that influence the implementation of science inquiry in the education systems of Turkey, Israel, Sweden and the Czech Republic. Data was collected by means of recordings of science experts' discussions as part of an EU-funded project called Science-Teacher Education Advanced Methods (2009-2012). Results of the qualitative analysis reveal that the following general indicators provide insight into the extent of implementation of inquiry-based science education (IBSE): (1) curriculum (2) assessment (3) policy and (4) teacher professionalization systems. In a second step comparative analyses of the four countries' education systems were conducted with regard to these indicators. To compare these factors we refer to both the framework of neo-institutional theories that explore the emergence of isomorphic educational models and to results from comparative studies emphasizing the influence of the countries' individual structure and cultural practices on modifying global pressure to convergence. Results show that in each of the countries these indicators influence the implementation of science inquiry to varying degrees. Moreover, as a result of the comparative analyses further country specific factors important for implementing science inquiry were found: (5) the need to improve existing teaching methods, (6) predominant teaching patterns, (7) infrastructure that enables changes in education and (8) education system's general goals that correlate with reforms.
This article addresses several issues pertinent to health systems governance for health equity. It argues the importance of health systems using measures of positive health (well-being), discriminating in favour of historically less advantaged groups and weighing the costs of health care against investments in the social determinants of health. It cautions that the concept of governance could weaken the role of government, with disequalizing effects, while emphasizing the importance of two elements of good governance (transparency and participation) in health systems decision-making. It distinguishes between participation as volunteer labour and participation as exercising political rights, and questions the assumption that decentralization in health systems is necessarily empowering. It then identifies five health system roles to address issues of equity (educator/watchdog, resource broker, community developer, partnership developer and advocate/catalyst) and the implications of these roles for practice. Drawing on preliminary findings of a global research project on comprehensive primary health care, it discusses political aspects of progressive health system reform and the implications of equity-focused health system governance on health workers' roles, noting the importance of health workers claiming their identity as citizens. The article concludes with a commentary on the inherently political nature of health reforms based on equity; the necessary confrontation with power relations politics involves; and the health systems governance challenge of managing competing health discourses of efficiency and results-based financing, on the one hand, and equity and citizen empowerment, on the other.
telemonitoring . In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient ...Lama, J Vila: “Intelligent Telemonitoring of Critical Care Patients ”, IEEE EMB Mag, Vol 18, No 4, pp 80-88, Jul/Aug 1999.  Strode S, Gustke S...Abstract- In this study we present a multipurpose health care telemedicine system, which can be used for emergency or patient monitoring cases
Ezzati, Majid; Bailis, Rob; Kammen, Daniel M.; Holloway, Tracey; Price, Lynn; Cifuentes, Luis A.; Barnes, Brendon; Chaurey, Akanksha; Dhanapala, Kiran N.
It is well-documented that energy and energy systems have a central role in social and economic development and human welfare at all scales, from household and community to regional and national (41). Among its various welfare effects, energy is closely linked with people s health. Some of the effects of energy on health and welfare are direct. With abundant energy, more food or more frequent meals can be prepared; food can be refrigerated, increasing the types of food items that are consumed and reducing food contamination; water pumps can provide more water and eliminate the need for water storage leading to contamination or increased exposure to disease vectors such as mosquitoes or snails; water can be disinfected by boiling or using other technologies such as radiation. Other effects of energy on public health are mediated through more proximal determinants of health and disease. Abundant energy can lead to increased irrigation, agricultural productivity, and access to food and nutrition; access to energy can also increase small-scale income generation such as processing of agricultural commodities (e.g., producing refined oil from oil seeds, roasting coffee, drying and preserving fruits and meats) and production of crafts; ability to control lighting and heating allows education or economic activities to be shielded from daily or seasonal environmental constraints such as light, temperature, rainfall, or wind; time and other economic resources spent on collecting and/or transporting fuels can be used for other household needs if access to energy is facilitated; energy availability for transportation increases access to health and education facilities and allow increased economic activity by facilitating the transportation of goods and services to and from markets; energy for telecommunication technology (radio, television, telephone, or internet) provides increased access to information useful for health, education, or economic purposes; provision of energy
Larsson, J; Landstad, B J; Wiklund, H; Vinberg, S
Statistical process control (SPC) charts have not been widely used to monitor workplace health and work environments. This research and effort to develop a more accurate and easy to use management control system for employee health is important from a humanistic, societal and economic standpoint, as well as complying with laws that regulate work environments. The purpose of the study is to design and discuss control charts as an early warning system for workplace health outcomes to promote workplace health management. Another purpose is to discuss relevant factors in the concept of the out-of-control action plan (OCAP) as a response when a chart warns that the workplace process may be malfunctioning. Two Swedish organizations were selected as case study organizations: a department at a university and an elderly care operation in a municipality. This study was explorative and should be seen as a starting point in learning how to use control charts for workplace health management. Self-assessed general health and new sick-cases per employee were selected as indicators for the control charts. An integrated early warning system with Cumulative Sums- and Shewhart-charts are presented to show a possible method as to how an early warning system can be structured through the use of statistical control charts. The conclusion of this study is that control charts, along with well-designed implementation, make up a powerful and useable managerial early-warning system which promotes workplace health and helps to prevent sickness absence.
Markström, Urban; Lindqvist, Rafael
This article analyzes the state of community mental health services for people with psychiatric disabilities and the interplay between different organizational levels. The study is based on document analysis and interviews with stakeholders in 10 Swedish municipalities. The results show how systems are slow to change and are linked to local traditions. The services are often delivered in closed settings, and the organizations struggle to meet the needs of a new generation of users. There is a gap between local systems and national policies because the latter pays attention to the attributes of a recovery approach.
U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...
Ibrahim, Jennifer K; Burris, Scott; Hays, Scott
The importance of law in the organization and operation of public health systems has long been a matter of interest to public health lawyers and practitioners, but empirical research on law as a factor in health system performance has been limited in quantity and sophistication. The emergence of Public Health Law Research and Public Health Systems and Services Research within a coordinated effort to strengthen public health research and practice has dramatically changed matters. This article introduces Public Health Law Research as an integral part of Public Health Systems and Services Research, discusses the challenges of integrating the 2 fields, and highlights 2 examples of current research that demonstrate the benefits of an integrated approach to improve the use of law in public health practice.
Fredlund, Cecilia; Svedin, Carl Göran; Priebe, Gisela; Jonsson, Linda; Wadsby, Marie
Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury. A representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made. Sex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common. Sex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents.
Full Text Available Anna Mårtensson,1 Thord Karlsson,2 Jan-Gunnar Gustafsson31Department of Soil and Environment, 2Department of Economics, Swedish University of Agricultural Sciences, Uppsala, Sweden; 3Bio Evaluation AB, Uppsala, SwedenAbstract: As there is an increasing interest for setting up vineyards and wineries in Sweden, a cost analysis is becoming necessary. In this study, we assessed the potential for wine production in Sweden. The estimated annual costs varied from €15.1/per L for production of 1800 L wine per ha to €41.9 for 525 L per ha. For an annual production of 1800 L per ha potentially achieved in an established vineyard, the capital requirement is €730,000. It would take 6 years for the investment to be paid off if the wine was sold for €37.5 per L. The high production costs mean that the only viable option for success is to orientate production towards the exclusive upper segment.Keywords: cold climate conditions, wine production costs, wine quality
Wang, Yunli; Liu, Zhenkai
Consumers face barriers when seeking health information on the Internet. A Personalized Health Information Retrieval System (PHIRS) is proposed to recommend health information for consumers. The system consists of four modules: (1) User modeling module captures user’s preference and health interests; (2) Automatic quality filtering module identifies high quality health information; (3) Automatic text difficulty rating module classifies health information into professional or...
The impacts of disasters are numerous and devastating on both the health of the human populations and the vital infrastructure. Public health therefore views disasters ... disasters on public health and the health care system within the fundamental principles that guide the ..... An uncontrolled fire occurring in vegetation more.
Swedish has a complicated prosodic system, compared, for example, with English. A large proportion of Swedish children with language impairment (LI) have prosodic problems to some extent. There are few descriptions in the literature of prosody intervention, which means that clinicians must rely on their overall linguistic and therapeutic knowledge…
Wermke, Wieland; Forsberg, Eva
This article discusses teacher autonomy in the case of the Swedish teaching profession since the 1980s. It is argued that deregulation, decentralization, and marketization reforms of the 1990s have indeed increased teacher autonomy, but in some respects also led to a increase of complexity in the Swedish school system. In order to handle this…
Nutley, Tara; Reynolds, Heidi W.
Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve.Objective: To...
Ho, Kendall; Al-Shorjabji, Najeeb; Brown, Ed; Zelmer, Jennifer; Gabor, Nancy; Maeder, Anthony; Marcelo, Alvin; Ritz, Derek; Messina, Luiz; Loyola, Margarita; Abbott, Patricia; Nazira, Jaffer; McKinnon, Annette; Dissanayake, Vajira; Akeel, Aisha; Gardner, Neil; Doyle, Thomas
Since the 1978 Declaration of Alma-Ata affirming health as a fundamental human right, policy-makers and stakeholders have proposed many different strategies to achieve the goal of 'health for all'. However, globally there still remains a lack of access to health information and quality health care, especially in low- and middle-income countries (LMIC). Digital health holds great promise to improve access and quality of care. We propose using the "resilient health system framework" as a guide to scale-up digital health as a means to achieve universal health care (UHC) and health for all. This article serves as a call to action for all governments to include population-based digital health tools as a foundational element in on-going health system priorities and service delivery.
Maeda, Toshiyuki; Okamoto, Tadayuki; Fukushige, Yae
We focus on health education as preventing health disorder of student youth and improving "health literacy", and present an improved system for health education. This system consists of registration management subsystem, short examination (quiz) management subsystem, questionnaire subsystem, and message delivery subsystem.
Jun 10, 2016 ... There is limited evidence on how electronic health (eHealth) technologies can be used to enable the governance and functioning of health systems in ... It aims to deepen understanding of the relationship between eHealth, equity, governance, and systems integration and build research capacity through ...
include all organisations that influence health, whether they provide health services, address broader conditions for improved health or represent the users and communities that strive for better health. However health systems simply lack the capacity to measure or understand their own weaknesses...... of providers, health workers and communities in reaching consensus on needed, demanded and affordable health action in each setting (e.g. district)....
Santavirta, Torsten; Santavirta, Nina; Betancourt, Theresa S; Gilman, Stephen E
To compare the risks of admission to hospital for any type of psychiatric disorder and for four specific psychiatric disorders among adults who as children were evacuated to Swedish foster families during the second world war and their non-evacuated siblings, and to evaluate whether these risks differ between the sexes. Cohort study. National child evacuation scheme in Finland during the second world war. Children born in Finland between 1933 and 1944 who were later included in a 10% sample of the 1950 Finnish census ascertained in 1997 (n = 45,463; women: n = 22,021; men: n = 23,442). Evacuees in the sample were identified from war time government records. Adults admitted to hospital for psychiatric disorders recorded between 1971 and 2011 in the Finnish hospital discharge register. We used Cox proportional hazards models to estimate the association between evacuation to temporary foster care in Sweden during the second world war and admission to hospital for a psychiatric disorder between ages 38 and 78 years. Fixed effects methods were employed to control for all unobserved social and genetic characteristics shared among siblings. Among men and women combined, the risk of admission to hospital for a psychiatric disorder did not differ between Finnish adults evacuated to Swedish foster families and their non-evacuated siblings (hazard ratio 0.89, 95% confidence interval 0.64 to 1.26). Evidence suggested a lower risk of admission for any mental disorder (0.67, 0.44 to 1.03) among evacuated men, whereas for women there was no association between evacuation and the overall risk of admission for a psychiatric disorder (1.21, 0.80 to 1.83). When admissions for individual psychiatric disorders were analyzed, evacuated girls were significantly more likely than their non-evacuated sisters to be admitted to hospital for a mood disorder as an adult (2.19, 1.10 to 4.33). The Finnish evacuation policy was not associated with an increased overall risk of admission to hospital
National Aeronautics and Space Administration — For supporting NASA's Robotics, Tele-Robotics and Autonomous Systems Roadmap, we are proposing the "Evolutionary Autonomous Health Monitoring System" (EAHMS) for...
Johansson, H; Odén, A; Lorentzon, M; McCloskey, E; Kanis, J A; Harvey, N C; Karlsson, M K; Mellström, D
The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population born in Sweden. Thus, the use of a FRAX® model in immigrants overestimates the risk of fracture, and the use of country of origin-specific models may be more appropriate. Age-specific fracture and mortality rates vary between countries so that FRAX tools are country-specific. In the case of immigrants, it is not known whether the model for the original or the new country is most appropriate. The aim of this study was to compare the incidence of hip fractures in foreign-born and Swedish-born individuals residing in Sweden. We studied the incidence of hip fracture in all men and women aged 50 years or more in Sweden between 1987 and 2002. The population comprised 2.8 million Swedish-born and 270,000 foreign-born individuals. Incident hip fractures occurred in 239,842 Swedish-born and 12,563 foreign-born individuals. The hip fracture incidence rose with age for both groups and was higher for women than men amongst both Swedish-born and foreign-born individuals. The hip fracture incidence for the Swedish-born cohort was approximately twice that of immigrants. For example, at the age of 70 years, the annual hip fracture incidence (per 100,000) was 450 (95 % CI 446-454) for a Swedish-born woman and 239 (95 % CI 223-257) for a foreign-born woman at the time of immigration. The hip fracture incidence rose slowly with time from immigration (0.6 % per annum, 95 % CI 0.5-0.8 %) but remained significantly lower than for Swedish-born individuals even after 40 years of residence. The incidence of hip fracture in Sweden is substantially lower in immigrants than in the population native to Sweden. Although there was a small rise in age- and sex-specific incidence after immigration, the incidence remained markedly lower than that observed in Swedish-born individuals. Thus, the use of a FRAX model for Sweden will overestimate the risk of fracture for foreign-born individuals living
An exploration of the connection between two meaning perspectives: an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context.
Ekblad, Solvig; Linander, Andrea; Asplund, Maria
The right to health care is significant for asylum seekers, particularly as many of them have experienced traumatic life events in their home country, during flight or in their host country. Post-migration living conditions have more impact than pre-migration conditions on ill health among asylum seekers, which underscores the importance of health care-related refugee reception policies. The purpose of this article is to explore the perceived meaning of comprehensive health information provided by a nurse to Arabic- and Somali-speaking adult asylum seekers, in a Swedish context, during its introduction at the Migration Board. In our study, the endpoint was whether asylum seekers found such health information relevant, understandable and respectful. Following an oral presentation, participants filled in a questionnaire consisting of three close-ended questions. A total of 39 groups of presentation attendees included 626 asylum seekers (415 Arabic- and 211 Somali-speaking). Data were analysed with descriptive statistics. Comments underwent content analysis. We also present some socio-demographic data on these asylum seekers. Independently of gender and language, the participants expressed their gratitude for and the meaningfulness of receiving professional, fact-based information, as well as being treated with concern and respect. They indicated a great need for this and felt relieved by being listened to. They liked the pedagogic group method, the opportunity for dialogue and to practice exercising their rights. These promising results indicate that exercising the asylum-seekers' right to receive such health information would improve future reception policies not only in Sweden, but throughout the EU. A renewed focus on communication and pedagogic skills, instead of just cultural training, should be considered for health care professionals assisting asylum seekers.
Lindqvist, A S; Moberg, T; Eriksson, B O; Ehrnborg, C; Rosén, T; Fahlke, C
The knowledge concerning the long-term effect of former anabolic androgenic steroids (AAS)-use on mental health is sparse. This study aims to investigate whether previous AAS-use affects mental health, present sociodemographic data, sport activity and substance abuse in a retrospective 30-year follow-up study of former elite athletes. Swedish male-elite power sport athletes (n=683) on the top 10 national ranking lists during any of the years 1960-1979 in wrestling, Olympic lifting, powerlifting and the throwing events in track and field answered a questionnaire. At least 20% of the former athletes admitted previous AAS-use. They had more often sought professional expertise for mental problems and had used illicit drugs compared to those not having used AAS. The AAS-users also differed in former sport activity pattern compared to non AAS-users. It is clear that a relationship exists between use of AAS and mental-health problems. Further studies need to be done in order to clarify this relationship.
Zhou, Wei; Xiao, Shuiyuan
Mental health is a challenging public health issue worldwide and surveillance is crucial for it. However, mental health surveillance has not been developed until recently in certain developed countries; many other countries, especially developing countries, have poor or even no health information systems. This paper presents surveillance related to mental health in China, a developing country with a large population of patients with mental disorders. Detailed information of seven relevant sur...
Andersson, Jonas E
the country. Global news media paralleled the Swedish situation with previous incidents in Paris in 2007, Athens in 2008 and London in 2011. Foreign offices, among others the American, British, Danish, and Norwegian ones, advised their citizens not to travel to Sweden: the Swedish welfare model...... and a high unemployment rate. The young generation experienced a Bonjour Tristesse! existence going in and out of unemployment. An existing dismay with architecture and physical planning of suburbia surfaced: The plausible responsibility of the body of architects was debated, since many esteemed profiles...... of the Swedish functionalist architecture had been involved in its realisation. One representative of the profession stated the need for upgrading the existing architecture to new user needs, while another one emphasised that the real group of inhabitants in suburbia is often not the group of users envisioned...
Pelle G. Lindqvist
Full Text Available Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism. We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.
Petersen, Poul Erik
Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care...... is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral...... diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work...
Farcas, D D
In Romania a Health Management Information System (HMIS) project is in progress. The project covers the main activities of the Ministry of Health (MoH), of the 42 District Health Authorities and more than 250 other health care units. The first applications will be implemented at the middle of 1999. The paper shows the context of the HMIS among other Health Information Systems in Romania, its main parts and some organizational issues of the HMIS project, achievements and difficulties encountered.
Kidia, Khameer; Machando, Debra; Mangezi, Walter; Hendler, Reuben; Crooks, Megan; Abas, Melanie; Chibanda, Dixon; Thornicroft, Graham; Semrau, Maya; Jack, Helen
There has been little external analysis of Zimbabwe's mental health system. We did a systems analysis to identify bottlenecks and opportunities for mental health service improvement in Zimbabwe and to generate cost-effective, policy-relevant solutions. We combined in-depth interviews with a range of key stakeholders in health and mental health, analysis of mental health laws and policies, and publicly available data about mental health. Five themes are key to mental health service delivery in Zimbabwe: policy and law; financing and resources; criminal justice; workforce, training, and research; and beliefs about mental illness. We identified human resources, rehabilitation facilities, psychotropic medication, and community mental health as funding priorities. Moreover, we found that researchers should prioritise measuring the economic impact of mental health and exploring substance use, forensic care, and mental health integration. Our study highlights forensic services as a central component of the mental health system, which has been a neglected concept. We also describe a tailored process for mental health systems that is transferable to other low-income settings and that garners political will, builds capacity, and raises the profile of mental health. Copyright © 2017 Elsevier Ltd. All rights reserved.
Figueroa, Jorge; Smith, Harvey; Morris, Jon
This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.
Health systems face the challenge of helping to improve health conditions. They occupy a priority place in middle- and lower-income countries, since the absence or fragility of health systems adversely impacts expected health outcomes. Thus, due to the direct relationship between programs and systems, the absence or weakness of either will result in a consequent deficiency in public health and the very execution of the programs. In the same vein, weakened health systems are one of the main bottlenecks to attaining the Millennium Development Goals. Systems thinking is one of the "four revolutions in progress" that are helping to transform health and health care systems. Within that framework, this article identifies conceptual and operational elements of systems applicable to health systems that contribute to overcoming the obstacles and inertia that hinder health activities and outcomes. It discusses relevant concepts characteristic of systems thinking, such as structural variables and dynamic complexity, the relationship between programs and health systems, and the monitoring and evaluation function, together with the role of innovation and systems integration as high-priority elements. This will aid in the development of designs that also stress the context of the components that guide management, identifying processes and outcomes in a health management continuum.
population epidemics of communicable diseases ... A. U. Akpan-Idiok, Department of Soil Science, University of Calabar, Calabar, Cross River State, ... (American. Public. Health. Association, 1996). This paper examines concept of disasters, impacts of disasters and implications on Public Health and Health Care System.
Health Rights and Equity-oriented Health System Change in Maharashtra, India. The private sector is the largest health provider in India, and ... Six world-class research teams to investigate overcoming therapeutic resistance in high fatality cancers. The world-class research teams will direct their focus towards new frontiers ...
Department of Veterans Affairs — Occupational Health Record-keeping System (OHRS) is part of the Clinical Information Support System (CISS) portal framework and the initial CISS partner system. OHRS...
The effective planning, management monitoring and evaluation of health services, health resources and indeed the health system requires a wealth of health information, with its simultaneous effective and efficient management. It is an instrument used to help policy-making, decision making and day to day actions in the ...
It is therefore eminent that sustainable health care development that can benefit all the people of this country should harness a synergy between indigenous health care systems, scientific research and modern health care methods. This article attempts to address the historical evolution of health care methods in South Africa ...
Fourth Global Health Systems Research Symposium features innovative research on improving maternal and child health in Africa. January 13, 2017. Image. Sue Szabo and Karina Gould at HSR2016 Conference. IDRC / Louise Guenette. Sue Szabo and Karina Gould at the Fourth Global Symposium on Health Systems ...
Governance for Equity in Health Systems (GEHS) program is leading the way in strengthening governance for equitable health systems to improve health outcomes in. LMICs. Building on a strong foundation and demonstrated results, GEHS in this third programming phase (2011-2016) will apply a sharper governance and ...
Dec 2, 2014 ... A new publication, Participatory Action Research in Health Systems: a methods reader, was launched at the Third Global Symposium on Health Systems Research in Cape Town, South Africa in October 2014. The reader was published by the Regional Network for Equity in Health in East and Southern ...
Donald Combs, C.; Barham, S.R.; Sloot, P.M.A.
Systems biology addresses interactions in biological systems at different scales of biological organization, from the molecular to the cellular, organ, organism, societal, and ecosystem levels. This chapter expands on the concept of systems biology, explores its implications for individual patients
Sen, Gita; Govender, Veloshnee
Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).
Monkman, Helen; Kushniruk, Andre W
Derived from overlapping concepts in consumer health, a consumer health information system refers to any of the broad range of applications, tools, and educational resources developed to empower consumers with knowledge, techniques, and strategies, to manage their own health. As consumer health information systems become increasingly popular, it is important to explore the factors that impact their adoption and success. Accumulating evidence indicates a relationship between usability and consumers' eHealth Literacy skills and the demands consumer HISs place on their skills. Here, we present a new model called the Consumer Health Information System Adoption Model, which depicts both consumer eHealth literacy skills and system demands on eHealth literacy as moderators with the potential to affect the strength of relationship between usefulness and usability (predictors of usage) and adoption, value, and successful use (actual usage outcomes). Strategies for aligning these two moderating factors are described.
Andreeva, Elena; Magnusson Hanson, Linda L; Westerlund, Hugo; Theorell, Töres; Brenner, M Harvey
Few studies have examined depression as both a cause and effect of unemployment, but no prior work investigated these relationships in the context of organisational downsizing. We explored whether the exposure to downsizing is associated with subsequent depression (social causation), and whether pre-existing depression increases the risk of being laid off when organisations downsize (health selection). Two successive waves of the nationally representative Swedish Longitudinal Occupational Survey of Health represented the baseline (2008) and follow-up (2010) of this study. Analyses included 196 workers who lost their jobs through downsizing, 1462 layoff survivors remaining in downsized organisations and 1845 employees of non-downsized workplaces. The main outcomes were: (1) Depressive symptoms at follow-up, assessed with a brief subscale from the Symptom Checklist 90, categorised by severity levels ("major depression", "less severe symptoms" and "no depression") and analysed in relation to earlier downsizing exposure; (2) Job loss in persons with downsizing in relation to earlier depressive symptoms. The associations were assessed by means of multinomial logistic regression. Job loss consistently predicted subsequent major depression among men and women, with a somewhat greater effect size in men. Surviving a layoff was significantly associated with subsequent major depression in women but not in men. Women with major depression have increased risks of exclusion from employment when organisations downsize, whereas job loss in men was not significantly influenced by their health. The evidence from this study suggests that the relative importance of social causation and health selection varies by gender in the context of organisational downsizing. Strategies for handling depression among employees should be sensitive to gender-specific risks during layoffs. Policies preventing social exclusion can be important for female workers at higher risk of depression.
Full Text Available Abstract Background Working life is an important arena in most people's lives, and the working line concept is important for the development of welfare in a society. For young people, the period before permanent establishment in working life has become longer during the last two decades. Knowledge about attitudes towards work can help us to understand young people's transition to the labour market. Adolescents are the future workforce, so it seems especially important to notice their attitudes towards work, including attitudes towards the welfare system. The aim of this study was to describe and analyse upper secondary school students' work attitudes, and to explore factors related to these attitudes. Methods The sample consisted of 606 upper secondary school students. They all received a questionnaire including questions about quality of life (QOL, sense of coherence (SOC, subjective health and attitudes towards work. The response rate was 91%. A factor analysis established two dimensions of work attitudes. Multivariate analyses were carried out by means of logistic regression models. Results Work ethics (WE and general work attitudes (GWA were found to be two separate dimensions of attitudes towards work. Concerning WE the picture was similar regardless of gender or study programme. Males in theoretical programmes appeared to have more unfavourable GWA than others. Multivariate analyses revealed that good QOL, high SOC and good health were significantly related to positive WE, and high SOC was positively related to GWA. Being female was positively connected to WE and GWA, while studying on a practical programme was positively related to GWA only. Among those who received good parental support, GWA seemed more favourable. Conclusion Assuming that attitudes towards work are important to the working line concept, this study points out positive factors of importance for the future welfare of the society. Individual factors such as female gender
Rice, J A; Isakova, L; Zelckovich, R; Frid, E
Integrated health care systems: a concept being discussed throughout Russia and the world. A concept with three different applications and a confusing interaction with the concept of "capitation payments." The health reform debate in Russia and the NIS can only advance if greater clarity is found for these concepts, and if medical leaders are prepared for the substantial changes in provider behavior that are required with integrated health care systems fueled by capitation payments. This article explores the twin concepts of capitation and integrated health care systems, and then the leadership challenges for Russian health sector managers as they prepare for these challenges of the twenty-first century.
Brinkerhoff, Derick W; Bossert, Thomas J
Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports 'best fit' solutions and accommodates political realities in health systems strengthening. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.
Shen, Li; Ye, Benchen; Sun, Huimin; Lin, Yuxin; van Wietmarschen, Herman; Shen, Bairong
To date, most of the chronic diseases such as cancer, cardiovascular disease, and diabetes, are the leading cause of death. Current strategies toward disease treatment, e.g., risk prediction and target therapy, still have limitations for precision medicine due to the dynamic and complex nature of health. Interactions among genetics, lifestyle, and surrounding environments have nonnegligible effects on disease evolution. Thus a transition in health-care area is urgently needed to address the hysteresis of diagnosis and stabilize the increasing health-care costs. In this chapter, we explored new insights in the field of health promotion and introduced the integration of systems theories with health science and clinical practice. On the basis of systems biology and systems medicine, a novel concept called "systems health" was comprehensively advocated. Two types of bioinformatics models, i.e., causal loop diagram and quantitative model, were selected as examples for further illumination. Translational applications of these models in systems health were sequentially discussed. Moreover, we highlighted the bridging of ancient and modern views toward health and put forward a proposition for citizen science and citizen empowerment in health promotion.
van de Pas, Remco; Ashour, Majdi; Kapilashrami, Anuj; Fustukian, Suzanne
The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Strömbäck, Maria; Malmgren-Olsson, Eva-Britt; Wiklund, Maria
Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women's experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden. A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17-25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis. The overall results of our interview analysis suggest that the stress management course we evaluated facilitated 'a space for gendered and embodied empowerment in a hectic life', implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants' narrated experiences of 'finding a social oasis to challenge gendered expectations', 'being bodily empowered', and 'altering gendered positions and stance to life' point to empowering processes of change that allowed them to cope with distress, despite
Background Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women’s experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden. Methods A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17–25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis. Results The overall results of our interview analysis suggest that the stress management course we evaluated facilitated ‘a space for gendered and embodied empowerment in a hectic life’, implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants’ narrated experiences of ‘finding a social oasis to challenge gendered expectations’, ‘being bodily empowered’, and ‘altering gendered positions and stance to life’ point to empowering processes of change that
Jonsson, E.; Banta, H.D.
Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed
Reine, I; Novo, M; Hammarström, A
To analyse the associations between unemployment and suboptimal self-rated health as well as high alcohol consumption, and to examine the role of possible mediating factors explaining the associations from a gender perspective. The sample, from a 14-year longitudinal study with a 96.4% response rate, consisted of 386 women and 478 men who were either employed or unemployed at 30 years of age. The health outcomes studied were suboptimal self-rated health and high alcohol consumption at 30 years of age. Logistic regression was used for analysis, and the relational theory of gender was used to discuss the findings. A strong relationship was found between unemployment and suboptimal self-rated health among women, and unemployment and high alcohol consumption among men, even after controlling for health-related selection, potential mediators and background factors. All mediating factors in the model were attributable to suboptimal self-rated health among unemployed women. Two mediating factors were also substantially related to high alcohol consumption among unemployed men. Long-term unemployment at a young age could have various health effects in men and women. At present, the mechanisms behind the health consequences are better understood among women. Research would benefit from developing theories in order to explain how youth unemployment leads to gendered health consequences. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
According to an influential narrative in Swedish educational historiography, the Swedish educational system underwent a drastic change during the 1990s, moving towards a more individualistic and marketised system. Without denying the relevance of this perspective, this article argues that we can trace antecedents to the reforms undertaken in the…
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
du Toit, Rènée; Faal, Hannah B; Etya'ale, Daniel; Wiafe, Boateng; Mason, Ingrid; Graham, Ronnie; Bush, Simon; Mathenge, Wanjiku; Courtright, Paul
The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective. A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework. Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care. Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide
Morse, Douglas E; Holm-Pedersen, Poul; Holm-Pedersen, Jytte
The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects.......The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects....
It also serves as an inventory control where statistics about a particular illness is known. Generally, Mobile Health Information System (MHIS) is built to help manage, control, and store health information, and at the same time help the health workers on field work to pass accurate and timely report to the necessary quarters.
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of
González Block Miguel
Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics
Canela-Soler, Jaume; Elvira-Martínez, David; Labordena-Barceló, María Jesús; Loyola-Elizondo, Enrique
Health Information Systems (HIS) are the core support to decision-making in health organizations. Within HIS, health indicators (HI) reflect, numerically, events measured in the health-illness continuum. The integrated health information system is intended to standardize, integrate and organize all the information available in health information systems through an accessible and secure repository, and to conveniently distribute information for decision-making. To standardize information it is necessary to define standards and semantic information to enable us to identify concepts and relate them uniquely to each other. The definition of a catalog of entities (DEA) with concepts, attributes and domains will enable the configuration of the information system, so there will be a catalog of entities (concepts of information and domains). Based on operational systems, analytical systems enabling management and strategy in the management of organizations will be built. The maximum level of analysis is the Balanced Score Card (BSC), which is established as the strategic tool for managers. It is necessary for the organization an integrated information system to plan, manage, evaluate and therefore provide managers with a decision tool for strategic and tactical decision-making in short and medium term. 2010 Elsevier España S.L. All rights reserved.
Matshidze, Patrick; Hanmer, Lyn
This chapter provides an overview of health information systems in the private health sector from a legislative and operational perspective, highlighting the duality of the South African health care...
GLOBAL JOURNAL OF MEDICAL SCIENCES VOL 9, NO. 1&2 ... disasters on public health and the health care system within the fundamental principles that guide the ..... Preparedness. • Assure capacity to respond effectively to disasters and emergencies. • Assess the populations at risk for special needs during a disaster.
With the recent passage of the National Defense Authorization Act for Fiscal Year 2017, Congress has triggered groundbreaking Military Health System organizational restructuring with the Defense Health Agency assuming responsibility for managing all hospitals and clinics owned by the Army, Navy, and Air Force. This is a major shift toward a modern value-based managed care system, which will require much greater military-civilian health care delivery integration to be in place by October 2018. Just before the National Defense Authorization Act for Fiscal Year 2017 passage, the Department of Defense had already begun a seismic shift and awarded a contract for the new Military Health System-wide electronic health record system. In this perspective, we discuss the implications of the intersection of two large-scope and large-scale initiatives, health system transformation, and information technology modernization, being rolled out in the largest and most complex federal agency and potential risk mitigating steps. The Military Health System will require an expanded unified clinical leadership to spearhead short-term transformation; furthermore, developing, organizing, and growing a cadre of informatics expertise to expand the use and diffusion of novel solutions such as health information exchanges, data analytics, and others to transcend organizational barriers are still needed to achieve the long-term aim of health system reform as envisioned by the National Defense Authorization Act for Fiscal Year 2017. © Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: email@example.com.
Designing and Conducting Health Systems Research Projects Volume 2: Data Analyses and Report Writing. Book cover Designing and Conducting Health Systems Research Projects Volume 2: Data Analyses and Report. Author(s):. Corlien M. Varkevisser, Indra Pathmanathan, and Ann Brownlee. Publisher(s):. KIT, IDRC.
Full Text Available Zachary Pruitt,1 Rahul Mhaskar,2 Bryan G Kane,3 Robert D Barraco,4 Deborah J DeWaay,2 Alex M Rosenau,3 Kristin A Bresnan,5 Marna Rayl Greenberg3 1Department of Health Policy and Management, College of Public Health, Morsani College of Medicine, University of South Florida, Tampa, FL, 2Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, 3Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, 4Department of Surgery, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, 5Department of Family Medicine, Morsani College of Medicine, University of South Florida, Lehigh Valley Campus, Allentown, PA, USA Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution.Methods: This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys.Results: To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated
Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica
The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.
A study was made of the endoparasites in specimens of Rana arvalis and R. temporaria collected on two occasions from a locality of southern Sweden. Some frogs were investigated directly after capture while other frogs were kept hibernating and the composition of the parasites as well as the behav...... not previously been reported from Sweden. The late Prof. O. Nybelin's unpublished records of parasites found in Swedish amphibians are also given....
Thomas Ostros, Sweden's new science minister is aiming to improve links with the science community, severely strained during the tenure of Carl Tham. Significantly, he confirmed that he will not be making any further changes to the managment of the Swedish Foundation for Strategic Research. He also announced a 5 per cent increase in government funding for science which will be used to strengthen basic research and education (1 page).
Brogårdh-Roth, Susanne; Månsson, Johanna; Ridell, Karin; Alward, Lubna; Hellén-Halme, Kristina; Ekberg, EwaCarin
There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one's general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene. A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17-19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation. Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17-19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups. Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with
von Essen Louise
Full Text Available Abstract Background There is a paucity of research about health-related quality of life (HRQL among adolescents, as studies have to a large extent focused on adults. The main aim was to provide information for future studies in this growing field by presenting normative data for the Short Form 36 (SF-36 and the Hospital Anxiety and Depression Scale (HADS for Swedish adolescents and young adults. Additionally, the influence of age and gender, as well as method of administration, was investigated. Methods A sample of 585 persons aged 13–23 was randomly chosen from the general population, and stratified regarding age group (young adolescents: 13–15 years; older adolescents: 16–19 years, and young adults: 20–23 years and gender (an equal amount of males and females. Within each stratum, the participants were randomized according to two modes of administration, telephone interview and postal questionnaire, and asked to complete the SF-36 and the HADS. Descriptive statistics are presented by survey mode, gender, and age group. A gender comparison was made by independent t-test; and one-way ANOVA was conducted to evaluate age differences. Results Effects of age and gender were found: males reported better health-related quality of life than females, and the young adolescents (13–15 years old reported better HRQL than the two older age groups. The older participants (16–23 years old reported higher scores when interviewed over the telephone than when they answered a postal questionnaire, a difference which was more marked among females. Interestingly, the 13–15-year-olds did not react to the mode of administration to the same extent. Conclusion The importance of taking age, gender, and method of administration into consideration, both when planning studies and when comparing results from different groups, studies, or over time, is stressed.
Kuo, Kuan-Liang; Fuh, Chiou-Shann
Health examinations play a key role in preventive medicine. We propose a health examination system named Health Examination Automatic Logic System (HEALS) to assist clinical workers in improving the total quality of health examinations. Quality of automated inference is confirmed by the zero inference error where during 6 months and 14,773 cases. Automated inference time is less than one second per case in contrast to 2 to 5 min for physicians. The most significant result of efficiency evaluation is that 3,494 of 4,356 (80.2%) cases take less than 3 min per case for producing a report summary. In the evaluation of effectiveness, novice physicians got 18% improvement in making decisions with the assistance of our system. We conclude that a health examination system with a clinical decision system can greatly reduce the mundane burden on clinical workers and markedly improve the quality and efficiency of health examination tasks.
Bengs, Carita; Johansson, Eva; Danielsson, Ulla; Lehti, Arja; Hammarström, Anne
Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.
Törnroos Née Kirves, Kaisa; Bernhard-Oettel, Claudia; Leineweber, Constanze
This study identified perceived employability trajectories and their associations with sleeping difficulties and depressive symptoms over time. The sample was part of the Swedish Longitudinal Survey on Health from 2008 to 2014 (n=4,583). Two stable trajectories (high and low perceived employability over time) and three trajectories with changes (increasing, decreasing, and V-shaped perceived employability over time) were identified. Workers with stable low perceived employability reported more sleeping difficulties and depressive symptoms than those who perceived high or increasing employability. Perceived employability is a rather stable personal resource, which is associated with well-being over time. However, changes in perceived employability do not seem to be echoed in well-being, at least not as immediately as theoretically expected.
Contracted Expeditionary Force Challenge - transforming the Manning system Swe Lead nation for EU NBG 11 + NBG 14 HEADQUARTERS SWEDISH ARMED...Sweden – Advanced parts of the SwAF, for example data-links within the Air Force since 1970-ies – Defence-, IT- and Telecomm industry...Information Management Portal (SHAREPOINT) Exercise Management System (EXONAUT) National simulation systems (TYR, JCATS, GESI, TCT) Air & Combat
Engh, Lisbet; Janson, Staffan; Svensson, Birgitta; Bornehag, Carl-Gustaf; Eriksson, Ulla-Britt
This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care. Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses. Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life. We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Olofsson, N; Lindqvist, K; Danielsson, I
To assess the association between fear of crime and/or psychological and/or physical abuse in relation to self-reported physical and psychological health, using a large representative sample of elderly women and men in Sweden. Cross-sectional national survey. Data were taken from a nationwide representative public health survey (2006). Men and women between the ages of 65 and 84 years were selected for the present analyses (4386 men and 4974 women). The response rate for this age group was 59% for men and 70% for women. Psychological and physical abuse against elderly women and men led to higher odds ratios for negative health outcomes, independently of socio-economic status. Strong correlation was found between psychological abuse and negative health outcomes in both men and women, while the correlation was less strong for physical abuse, especially among women. The men had high odds ratios for suicidal thoughts and even for attempted suicide in connection with physical and psychological abuse and fear of crime. The study provides representative results addressing an extensive negative health outcome panorama caused by fear of crime and exposure to abuse. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Koch, Edward F
The VA Maryland Health Care System introduced videoconferencing technology to provide psychiatry, evidenced-based psychotherapy, case management, and patient education at rural clinics where it was difficult to recruit providers. Telemental health services enable rural clinics to offer additional services, such as case management and patient education. Services have been expanded to urban outpatient clinics where a limited number of mental health clinic hours are available. This technology expands the availability of mental health providers and services, allowing patients to receive services from providers located at distant medical centers.
Bonus systems and their effects on safety: an interview-based pilot study at the Swedish nuclear power plants; Bonussystem och dess inverkan paa saekerheten: en intervjubaserad pilotstudie vid de svenska kaernkraftverken
Torbioern, Ingemar; Mattson, Malin (Inst. of Psychology, Stockholm Univ., Stockholm (Sweden))
The aim of this pilot study has been to describe and analyse potential effects on safety-related behaviour and risks associated with the bonus systems currently used at Swedish nuclear plants. To this end and in order to establish a frame of reference several theories on motivation were consulted regarding the relevance of monetary rewards. In addition empirical evidence on effects upon behaviours in general and safety behaviours in particular was taken into consideration, as well as a systems and a rationalist perspective on organisations. The resulting frame of reference was used for a descriptive mapping of the bonus systems and for the formulation of a semi-structured interview schedule intended to capture the experiences of those concerned by the systems. A total of 15 interviews were performed with staff of different functions and organisational positions. Results of the study do not indicate any negative effects on safety-related behaviours. Rather they indicate that safety-behaviours may be promoted insofar as bonus rewards are linked to performance goals concerning safety. All of the bonus-systems may be characterised as low in incentive intensity, i.e. produce small effects on motivation and performance. Still, as the systems differ in design and in the way they are perceived, they also represent different challenges in order to function more efficiently as parameters
Full Text Available This special issue of Education & Democracy presents examples froma new generation of Swedish research on environmental and sustainability education and thereby complement the picture of the current Swedish environmental and sustainability education research outlined in the recent Danish-Swedish special issue of Environmental EducationResearch (Vol 16, No 1 and the anthology Democracy and Values inEducation for Sustainable Development – Contributions from Swedish Research (Öhman 2008. All the contributors to this issue are associatedwith the Graduate School in Education and Sustainable Development (GRESD, either as PhD students or as supervisors.
Full Text Available Abstract The global situation for people with mental illness – in developing and developed countries – is dire. Legislative and human rights protections are frequently lacking. Mental health budgets are inadequate. There are insufficient numbers of skilled policy makers, managers and clinicians. Communities are poorly informed about mental health and illness and not well organised for purposes of advocacy. In most of the world, mental health services are inaccessible or of poor quality. Most people who would benefit from psychiatric treatment and rehabilitation do not have affordable access to such services. Leadership – at all levels – for mental health system development needs to be greatly strengthened. While mental health research attention and funds are devoted predominantly to neuroscience and clinical research, we believe that the highest global mental health research priority is mental health systems research. There is an urgent need to focus on the development of effective, appropriate, affordable mental health services. The evidence base for such development is currently weak. The International Journal of Mental Health Systems aims to stimulate greater attention to the central importance of building functioning mental health systems. Rapid publication and global reach through open access will make this journal a resource for all those who wish to contribute to such development.
Full Text Available The events in Ukraine, the annexation of Crimea, and the Russian attitude towards Ukraine show an evident change in European relations. The escalation of conflict between Russia and Ukraine however does not affect only those two countries, but also those in the nearest vicinity. Especially in Scandinavian and Nordic countries change in social ambience can be observed. The aim of this article is essentially to analyze Swedish reaction to the Ukrainian Crisis, the change in Swedish attitude towards international security systems, especially NATO, and Swedish perception of its national safety.
Berglund, Erik; Lytsy, Per; Westerling, Ragnar
Active traveling to a daily occupation means that an individual uses an active way of traveling between two destinations. Active travel to work or other daily occupations offers a convenient way to increase physical activity levels which is known to have positive effects on several health outcomes. Frequently used concepts in city planning and regional planning today are to create environments for active commuting and active living. Even then, little research has focused on traveling modes and subjective health outcomes such as self-rated health (SRH). This study aimed to explore and investigate associations between travel mode and health-related outcomes, such as self-rated health (SRH), body mass index (BMI) and overall physical activity, in an adult population in Sweden. A cross-sectional study was conducted in a randomly selected population-based sample (n = 1786, age 45-75 years); the respondents completed a questionnaire about their regular travel mode, demographics, lifestyle, BMI and SRH. Chi-square tests and logistic regressions found that inactive traveling was associated with poor SRH, a greater risk of obesity or being overweight and overall physical inactivity. In addition, lifestyle factors, such as choice of food and smoking habits, were associated with SRH, BMI and overall physical activity.
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Full Text Available Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.
Gordon, Max; Paulsen, Aksel; Overgaard, Søren
There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons of...... health-related quality of life (HRQoL) one year after total hip replacement (THR) surgery in Sweden and in Denmark.......There is an increasing focus on measuring patient-reported outcomes (PROs) as part of routine medical practice, particularly in fields such as joint replacement surgery where pain relief and improvement in health-related quality of life (HRQoL) are primary outcomes. Between-country comparisons...
Carrillo, E; Segovia, M; Paganini, J M
This report describes a management information system (MIS) designed by PAHO's Health Systems and Services Division in collaboration with technical experts from a number of different countries. This MIS, a methodology currently used at the institutional or national level in more than 21 countries of the Americas, is a strategic and practical instrument that is easy to apply, interpret, and use, and whose purpose is to facilitate fundamental changes in health management. Based on the management concept that inputs, processes, and outputs are quantifiable, the MIS places special emphasis on health system productivity, an essential condition for achieving health coverage that is both adequate and equitable.
Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless networking and are applicable to a wide range of health related information including medical data, biomedical data, bioinformatics data, public health data.
Simmons, Johanna; Wijma, Barbro; Swahnberg, Katarina
Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators. Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health. Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6-8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9-5.9). The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of
Yip, Winnie; Hsiao, William C
The Chinese government has committed to increasing government funding for health care by directing 1-1.5 percent of its gross domestic product to universal basic health care. However, China is at a loss as to how to transform its new money into efficient and effective health care. This paper critically examines the various options currently under heated debate in China. We argue that unless China tackles the root cause of unaffordable health care--rapid cost inflation caused by an irrational and wasteful health care delivery system--much of the new money is likely to be captured by providers as higher income and profits.
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
Bornehag, Carl-Gustaf; Sundell, Jan; Hagerhed, L.
-sectional questionnaire study on 14 077 children (1-6 years) focusing on their health and their home environment. There were strong and consistent associations between different "dampness"-indicators and symptoms among children. The combination of floor moisture problems and PVC as flooring material significantly...
Rolander, B.; Jonker, D.; Winkel, Jørgen
patients per dentist increased, and perceived physical working conditions improved while perceived work control and leadership deteriorated. Structural equation modelling showed that physical factors were important for health and productivity. When assessing risks in the work environment, there is a need...
Gadin, Katja Gillander; Weiner, Gaby; Ahlgren, Christina
A school health promotion project was carried out in an elementary school in Sweden where active participation, gender equality, and empowerment were leading principles. The objective of the study was to understand challenges and to identify social processes of importance for such a project. Focus group interviews were conducted with 6 single-sex…
Weaver, R Kent
Sweden's new multipillar pension system includes a system of mandatory fully funded individual accounts. The Swedish system offers contributors more than 600 fund options from a variety of private-sector fund managers. However, in the most recent rounds of fund choice, more than 90 percent of new labor market entrants have not made an active choice of funds and thus have ended up in a government-sponsored default fund. The Swedish system offers a number of lessons about implementing a mandatory individual account tier. Centralized administration keeps administrative costs down but requires considerable lead time. A very large number of fund options are likely to be offered unless strong entry barriers are in place. Engaging new labor market entrants in fund choice is likely to be difficult. A significant percentage of those making an active fund choice may choose funds that are very specialized and risky. Finally, special care must be devoted to designing a default fund and continual consumer communication.
Full Text Available Yuelian Sun,1 Hans Gregersen,2 Wei Yuan3 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2GIOME, Department of Surgery, Chinese University of Hong Kong, Hong Kong, 3Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, People’s Republic of China Abstract: China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide
O'Neill, Ciaran; McGregor, Pat; Merkur, Sherry
The political context within which Northern Irelands integrated health and social care system operates has changed since the establishment of a devolved administration (the Northern Ireland Assembly, set up in 1998 but suspended between 2002 and 2007). A locally elected Health Minister now leads the publicly financed system and has considerable power to set policy and, in principle, to determine the operation of other health and social care bodies. The system underwent major reform following the passing of the Health and Social Care (Reform) Act (Northern Ireland) in 2009. The reform maintained the quasi purchaser provider split already in place but reduced the number and increased the size of many of the bodies involved in purchasing (known locally as commissioning) and delivering services. Government policy has generally placed greater emphasis on consultation and cooperation among health and social care bodies (including the department, commissioners and care providers) than on competition. The small size of the population (1.8 million) and Northern Irelands geographical isolation from the rest of the United Kingdom provide a rationale for eschewing a more competitive model. Without competition, effective control over the system requires information and transparency to ensure provider challenge, and a body outside the system to hold it to account. The restoration of the locally elected Assembly in 2007 has created such a body, but it remains to be seen how effectively it will exercise accountability. World Health Organization 2012 (acting as the host organization for, and secretariat of, the European Observatory on health systems and Policies).
Full Text Available Abstract Background The total number of cardiovascular (CVD deaths accounted for almost a third of all deaths globally in 2013. Population based randomised controlled trials, managed within primary care, on CVD risk factor interventions are scarce. The aim of the study was to evaluate the effects of a health dialogue intervention in a primary care setting offered to a population at the age of 55 years, focusing on CVD risk factors. Methods The study was performed in five primary health care centres in the county of Västmanland, Sweden between April 2011 and December 2012. Men and women were randomly assigned to intervention (n = 440 and control groups (n = 440. At baseline, both groups filled in a health questionnaire and serum cholesterol, fasting plasma glucose, glycated haemoglobin (HbA1c, weight, height, waist (WC and hip circumference, waist hip ratio (WHR and systolic/diastolic blood pressure were measured. Intervention group attended a health dialogue, supported by a visualised health profile, with a possibility for further activities. Participation rates at baseline were 53% and 52% respectively. A 1-year follow-up was carried out. Results The intervention group (n = 165 showed reductions compared to the control group (n = 177 concerning body mass index (BMI (0.3 kg/m2, p = .031, WC (2.1 cm, p ≤ .001 and WHR (.002, p ≤ .001 at the 1-year follow-up. No differences between the intervention and control groups were found in other variables. Intervention group, compared to baseline, had reduced weight, BMI, WC, WHR, HbA1c, and diet, while the men in the control group had reduced their alcohol consumption. Conclusions A health dialogue intervention at the age of 55 years, conducted in ordinary primary care, showed a moderate effect on CVD risk factor levels, in terms of BMI, WC and WHR. Trial registration number BioMed Central, ISRCTN22586871 , date assigned; 10/12/2015
Stewart, W. Wayne; Allen, James W.; Bilella, James; O'Neill, Pat
The basic purpose of a health surveillance system is to detect changes in an employee's health status. These changes may uncover health threats from newly introduced or existing industrial/consumer substances. Stewart-Todd Associates has provided employee health monitoring services to a variety of industries for over 10 years. From these experiences the company developed a computerized health surveillance system called ETHOS. Advanced features of ETHOS include its adaptability to a variety of users' requirements, flexible data input structure, and reports that highlight trends for individuals or groups. Several companies in unrelated industries use ETHOS on a time-sharing basis. The storage of their employee data plus the reporting capabilities of ETHOS permit accumulation of a large employee data base. Such a data base will be a valuable resource for detecting adverse health effects to employees or substantiating claims of a substance's harmlessness.
Bisantz, Ann M; Fairbanks, Rollin J
Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...
Brem, Alexander; Sliwa, Sophie Isabel; Agarwal, Nivedita
This paper explores telecare as one of the practical applications in the field of e-health. Using 11 expert interviews the study evaluates development of cross-national analogies between the different institutional contexts of health systems in Germany, Austria, and Denmark. Telecare is treated...... as a set of ideas regarding future processes in health and home care services, involving technological solutions, starting to change stakeholders' behaviour, work practices, and social roles. A system-centric framework is proposed to evaluate the interdependencies between telecare, the changing...... relationships, and the institutional context. Complexity and documentation requirements were identified as major hindrances to the improvement of efficiency and quality of health outcomes in Austria and Germany. On the contrary, in Denmark, governmental guidance supporting patient-centered approaches was found...
Full Text Available Abstract Background Some people attribute their ill health to dental filling materials, experiencing a variety of symptoms. Yet, it is not known if they continue to financially support themselves by work or become reliant on different types of social security benefits. The aim of this study was to analyse reliance on different forms of social security benefits by patients who attribute their poor health to dental filling materials. Methods A longitudinal cohort study with a 13-year follow up. The subjects included were 505 patients attributing their ill health to dental restorative materials, who applied for subsidised filling replacement. They were compared to a cohort of matched controls representing the general population (three controls per patient. Annual individual data on disability pension, sick leave, unemployment benefits, and socio-demographic factors was obtained from Statistics Sweden. Generalized estimating equations were used to test for differences between cohorts in number of days on different types of social security benefits. Results The cohort of dental filling patients had a significantly higher number of days on sick leave and disability pension than the general population. The test of an overall interaction effect between time and cohort showed a significant difference between the two cohorts regarding both sick leave and disability pension. In the replacement cohort, the highest number of sick-leave days was recorded in the year they applied for subsidised replacement of fillings. While sick leave decreased following the year of application, the number of days on disability pension increased and peaked at the end of follow-up. Conclusions Ill health related to dental materials is likely to be associated with dependence on social security benefits. Dental filling replacement does not seem to improve workforce participation.
Doring, Nora; Hansson, Lena M; Andersson, Elina Scheers; Bohman, Benjamin; Westin, Maria; Magnusson, Margaretha; Larsson, Christel; Sundblom, Elinor; Willmer, Mikaela; Blennow, Margareta; Heitmann, Berit L.; Forsberg, Lars; Wallin, Sanna; Tynelius, Per; Ghaderi, Ata
Background Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative va...
Naimi-Akbar, Aron; Svedberg, Pia; Alexanderson, Kristina; Ekstrand, Jan; Sandborgh-Englund, Gunilla
Some people attribute their ill health to dental filling materials, experiencing a variety of symptoms. Yet, it is not known if they continue to financially support themselves by work or become reliant on different types of social security benefits. The aim of this study was to analyse reliance on different forms of social security benefits by patients who attribute their poor health to dental filling materials. A longitudinal cohort study with a 13-year follow up. The subjects included were 505 patients attributing their ill health to dental restorative materials, who applied for subsidised filling replacement. They were compared to a cohort of matched controls representing the general population (three controls per patient). Annual individual data on disability pension, sick leave, unemployment benefits, and socio-demographic factors was obtained from Statistics Sweden. Generalized estimating equations were used to test for differences between cohorts in number of days on different types of social security benefits. The cohort of dental filling patients had a significantly higher number of days on sick leave and disability pension than the general population. The test of an overall interaction effect between time and cohort showed a significant difference between the two cohorts regarding both sick leave and disability pension. In the replacement cohort, the highest number of sick-leave days was recorded in the year they applied for subsidised replacement of fillings. While sick leave decreased following the year of application, the number of days on disability pension increased and peaked at the end of follow-up. Ill health related to dental materials is likely to be associated with dependence on social security benefits. Dental filling replacement does not seem to improve workforce participation.
Stokes, Laura B.; Rogers, Joseph W.; Hertig, John B.; Weber, Robert J.
Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this artic...
Nguyen, Gloria; Torres, Abel
Most dermatologists agree that antioxidants help fight free radical damage and can help maintain healthy skin. They do so by affecting intracellular signaling pathways involved in skin damage and protecting against photodamage, as well as preventing wrinkles and inflammation. In today's modern world of the rising nutraceutical industry, many people, in addition to applying topical skin care products, turn to supplementation of the nutrients missing in their diets by taking multivitamins or isolated, man-made nutraceuticals, in what is known as the Inside-Out approach to skin care. However, ingestion of large quantities of isolated, fragmented nutrients can be harmful and is a poor representation of the kind of nutrition that can be obtained from whole food sources. In this comprehensive review, it was found that few studies on oral antioxidants benefiting the skin have been done using whole foods, and that the vast majority of current research is focused on the study of compounds in isolation. However, the public stands to benefit greatly if more research were to be devoted toward the impact that physiologic doses of antioxidants (obtained from fruits, vegetables, and whole grains) can have on skin health, and on health in general.
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to “traditional” issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a glo...
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Background: On ISTAT website the informative system Health for All – Italia is available. It collects indicators on health coming from various sources to make up a basis for constructing an organic and joint framework on the country’s health reality. The system includes more than 4000 indicators about: demographic and socioeconomic context; causes of death; life styles; disease prevention; chronic and infectious diseases; disability; health status and life expectancy; health facilities; hospital discharges by diagnosis; health care resources. The database-related software was developed by the World Health Organization to make it easier for any user to access the information available either as tables, graphs and territorial maps.
Methods: The system has been built considering data coming from different sources and using, if possible, the same definitions, classifications and desegregations. Time series goes from 1980 to the last year available (which can differ among the different sources. Indicators are calculated by provinces (if possible, regions, big areas and Italy. In order to compare indicators over time and space, standardised rates are calculated, using the same population reference. For each indicator metadata are available to give users additional notes necessary to correctly read and use the data, and publications or internet websites to examine more in-depth the argument.
Results: Different kind of users find Health for All – Italia very useful for their aims: students, researchers, doctors, socio-sanitary operators, policy makers. Some examples of official reports from public institutions are briefly described in the paper.
Conclusions: The increasing number of users of Health for All – Italia make necessary the online version and an English version for international comparisons.
Alami, Hassane; Gagnon, Marie-Pierre; Fortin, Jean-Paul
Information and communication technologies have transformed all sectors of society. The health sector is no exception to this trend. In light of "digital health", we see multiplying numbers of web platforms and mobile health applications, often brought by new unconventional players who produce and offer services in non-linear and non-hierarchal ways, this by multiplying access points to services for people. Some speak of a "uberization" of healthcare. New realities and challenges have emerged from this paradigm, which question the abilities of health systems to cope with new business and economic models, governance of data and regulation. Countries must provide adequate responses so that digital health, based increasingly on disruptive technologies, can benefit for all.
Kern, T; Kohnen, T
Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.
Apr 3, 2013 ... The health of mothers and their children depends on the status of women. Creativity and audacity. The first step is to understand that health systems are complex social entities. Then one needs to be creative, participatory, and audacious to implement interventions suitable to specific contexts. Walter Flores.
Strengthening Governance in Health Systems for Reproductive Health and Rights in Pakistan. Pakistan, with the world's sixth largest population, is part of a region that is notorious for its social and gender inequities. As a low-income country, its population has faced numerous economic challenges, especially in the last two ...
Apr 29, 2016 ... Weak health systems cause a high burden of preventable and treatable illnesses, especially for those living in rural areas. Strong ... Research in Uganda found that training community health workers in common childhood illnesses, such as malaria and diarrhea, increased the number of children receiving ...
Health systems in Africa have long faced a huge burden of disease, amidst pressing resource constraints. However, despite the constraints, the last three decades have seen the region make progress in tackling some of the most critical health challenges. Notably, many countries have registered
There have been some successes in reducing the disease burden through programs targeting specific communicable diseases such as tuberculosis, malaria, and HIV-AIDS. However, further improvements cannot be achieved without addressing broad health systems issues. This research project will strengthen health ...
Designing and Conducting Health Systems Research Projects Volume 2 : Data Analyses and Report Writing. Book cover Designing and Conducting Health ... Ebola Crisis: Improving Science-Based Communication and Local Journalism in Emergency and Post-outbreak Periods. The World Federation of Science Journalists ...
The focus will thus be on quality control, maintenance and documenting utilization. Mali currently has very little information ... Outputs. Reports. Building National Health Research Information System - COHRED : health research web; final technical report for the period March 27, 2008 - September 27, 2009. Download PDF.
Stokes, Laura B; Rogers, Joseph W; Hertig, John B; Weber, Robert J
Big Data refers to datasets that are so large and complex that traditional methods and hardware for collecting, sharing, and analyzing them are not possible. Big Data that is accurate leads to more confident decision making, improved operational efficiency, and reduced costs. The rapid growth of health care information results in Big Data around health services, treatments, and outcomes, and Big Data can be used to analyze the benefit of health system pharmacy services. The goal of this article is to provide a perspective on how Big Data can be applied to health system pharmacy. It will define Big Data, describe the impact of Big Data on population health, review specific implications of Big Data in health system pharmacy, and describe an approach for pharmacy leaders to effectively use Big Data. A few strategies involved in managing Big Data in health system pharmacy include identifying potential opportunities for Big Data, prioritizing those opportunities, protecting privacy concerns, promoting data transparency, and communicating outcomes. As health care information expands in its content and becomes more integrated, Big Data can enhance the development of patient-centered pharmacy services.
For example, when staff at TARSC asked people in participatory sessions to form a human sculpture to illustrate their perception of how health systems operated in terms of patient care, the sculpture most commonly showed health workers, managers, and others turning away from the patient and looking up to the next level ...
Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Available We propose a distributed system that enables global and ubiquitous health monitoring of patients. The biomedical data will be collected by wearable health diagnostic devices, which will include various types of sensors and will be transmitted towards the corresponding Health Monitoring Centers. The permanent medical data of patients will be kept in the corresponding Home Data Bases, while the measured biomedical data will be sent to the Visitor Health Monitor Center and Visitor Data Base that serves the area of present location of the patient. By combining the measured biomedical data and the permanent medical data, Health Medical Centers will be able to coordinate the needed actions and help the local medical teams to make quickly the best decisions that could be crucial for the patient health, and that can reduce the cost of health service.
Toniolo, Franco; Mantoan, Domenico; Maresso, Anna
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. This HiT is one of the first to be written on a subnational level of government and focuses on the Veneto Region of northern Italy. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Veneto Region is one of Italy's richest regions and the health of its resident population compares favourably with other regions in Italy. Life expectancy for both men and women, now at 79.1 and 85.2 years, respectively, is slightly higher than the national average, while mortality rates are comparable to national ones. The major causes of death are tumours and cardiovascular diseases. Under Italy's National Health Service, the organization and provision of health care is a regional responsibility and regions must provide a nationally defined (with regional input) basic health benefit package to all of their citizens; extra services may be provided if budgets allow. Health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. Historically, health budget deficits have been a major problem in most Italian regions, but since the early 2000s the introduction of efficiency measures and tighter procedures on financial management have contributed to a significant decrease in the Veneto Regions health budget deficit.The health system is governed by the Veneto Region government (Giunta) via the Departments of Health and Social Services, which receive technical support from a single General Management Secretariat. Health care is
National Aeronautics and Space Administration — Managing the health of vehicle, crew, and habitat systems is a primary function of flight controllers today. We propose to develop an architecture for automating...
Carlsson, Dick [Forestry Research Inst. of Sweden, Uppsala (Sweden); Roennqvist, M. [Linkoeping Univ. (Sweden). Dept. of Mathematics
In this paper we give an overview of the wood-flow in Sweden including a description of organization and planning. Based on that, we will describe a number of applications or problem areas in the wood-flow chain that are currently considered by the Swedish forest companies to be important and potential in order to improve overall operations. We have focused on applications which are short term planning or operative planning. We do not give any final results as much of the development is currently ongoing or is still in a planning phase. Instead we describe what kind of models and decision support systems that could be applied in order to improve co-operation within and integration of the wood-flow chain 13 refs, 20 figs, 1 tab
Full Text Available This paper examines the development of taxation in Sweden from 1862 to 2010. The examination includes six key aspects of the Swedish tax system, namely the taxation of labor income, capital income, wealth, inheritances and gifts, consumption and real estate. The importance of these taxes varied greatly over time and Sweden increasingly relied on broad-based taxes (such as income taxes and general consumption taxes and taxes that were less visible to the public (such as payroll taxes and social security contributions. The tax-to-GDP ratio was initially low and relatively stable, but from the 1930s, the ratio increased sharply for nearly 50 years. Towards the end of the period, the tax-to-GDP ratio declined significantly.
Hougaard, Jens Leth; Østerdal, Lars Peter Raahave; Yu, Yi
We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese h...
Health Information Science and Systems is an exciting, new, multidisciplinary journal that aims to use technologies in computer science to assist in disease diagnoses, treatment, prediction and monitoring through the modeling, design, development, visualization, integration and management of health related information. These computer-science technologies include such as information systems, web technologies, data mining, image processing, user interaction and interface, sensors and wireless n...
This report contains the Swedish opinion on Nuclear Power and European Attitudes on Nuclear Power. It also includes European Attitudes Towards the Future of Three Energy Sources; Nuclear Energy, Wind Power and Solar Power - with a focus on the Swedish opinion. Results from measurements done by the SOM Inst. are presented.
Gooskens, Charlotte; van Heuven, Vincent J.; van Bezooijen, Renee; Pacilly, Jos J. A.
The most straightforward way to explain why Danes understand spoken Swedish relatively better than Swedes understand spoken Danish would be that spoken Danish is intrinsically a more difficult language to understand than spoken Swedish. We discuss circumstantial evidence suggesting that Danish is
This report gives a thorough description of cadmium in the Swedish environment. It comprises three parts: Cadmium in Sweden - environmental risks;, Cadmium in goods - contribution to environmental exposure;, and Cadmium in fertilizers, soil, crops and foods - the Swedish situation. Separate abstracts have been prepared for all three parts
Fridh, Maria; Lindström, Martin; Rosvall, Maria
Victimization in cyberspace has emerged as a new public health issue among the young. The main purpose of this study was to analyze associations between cyber victimization defined as cyber harassment (CH) (a somewhat broader concept than cyberbullying) and subjective health complaints (SHC), to study whether these associations were modified by parental/friend support (measured as communication), and to explore the influence of traditional bullying victimization (TBV) on the association between CH and SHC. The study population consisted of 8544 students in 9th grade (around 15 years old) who participated in the 2012 Scania public health survey of children and adolescents. The survey was a cross-sectional total-population study conducted in school, with a response rate of 83 %. Main and interaction (stress-buffering) effects of social support on the relationship between CH and SCH were investigated by hierarchical multiple linear regression analyses, adjusted for potential confounders, including TBV. The past-year prevalence of CH (once or several times) was 14 % among boys and 20 % among girls. Having been cyber harassed once or several times during the past year was associated with higher levels of SHC, controlling for age, parental occupation, parental origin, daily smoking, intense alcohol consumption, and disability. Among both boys and girls, the associations were stronger for CH occurring several times than for CH occurring only once. Main effects of parental/friend support were seen for both boys and girls, while stress-buffering effects were indicated for boys only. Additional analysis further adjusting for TBV did not change the associations substantially, indicating that CH has an effect of its own on SHC. Intervention programs aimed at improving the quality of peer and family relationships among children and adolescents might reduce the incidence of both cyber harassment and traditional bullying and lower the prevalence of psychosomatic complaints.
Longley, Marcus; Riley, Neil; Davies, Paul; Hernandez-Quevedo, Cristina
Wales is situated to the west of England, with a population of approximately 3 million (5% of the total for the United Kingdom), and a land mass of just over 20 000 km2. For several decades, Wales had a health system largely administered through the United Kingdom Governments Welsh Office, but responsibility for most aspects of health policy was devolved to Wales in a process beginning in 1999. Since then, differences between the policy approach and framework in England and Wales have widened. The internal market introduced in the United Kingdom National Health Service (NHS) has been abandoned in Wales, and seven local health boards (LHBs; supported by three specialist NHS trusts) now plan and provide all health services for their resident populations. Wales currently has more than 120 hospitals as part of an overall estate valued at 2.3 billion pounds. Total spending on health services increased in the first decade of the 21st century, but Wales now faces a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Governments decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continues to face some structural weaknesses that have proved resistant to reform for some time. However, there has been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy has continued to increase, but health inequalities have proved stubbornly resistant to improvement. World Health Organization 2012 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).
A health monitoring expert system software architecture has been developed to support condition-based health monitoring of rocket engines. Its first application is in the diagnosis decisions relating to the health of the high pressure oxidizer turbopump (HPOTP) of Space Shuttle Main Engine (SSME). The post test diagnostic system runs off-line, using as input the data recorded from hundreds of sensors, each running typically at rates of 25, 50, or .1 Hz. The system is invoked after a test has been completed, and produces an analysis and an organized graphical presentation of the data with important effects highlighted. The overall expert system architecture has been developed and documented so that expert modules analyzing other line replaceable units may easily be added. The architecture emphasizes modularity, reusability, and open system interfaces so that it may be used to analyze other engines as well.
Full Text Available Introduction. The safety of vitamin K antagonists (VKA use can be compromised by many popular herbal supplements taken by individuals. The literature reports that 30% of warfarin-treated patients self-medicates with herbs. Possible interactions represent an health risk. We aimed to identify all herbs-oral anticoagulants interactions collected in the Italian database of suspected adverse reactions to “natural health” products. Methods. The Italian database of spontaneous reports of suspected adverse reactions to natural products was analyzed to address herb-VKAs interactions. Results. From 2002 to 2009, we identified 12 reports with 7 cases of INR reduction in patients treated with warfarin (n=3 and acenocoumarol (n=4, and 5 cases of INR increase (all warfarin associated. It was reported 8 different herbal products as possibly interacting. Discussion. Our study confirms the risk of interactions, highlighting the difficulty to characterize them and their mechanisms and, finally, prevent their onset. The reported data underline the urgent need of healthcare providers being aware of the possible interaction between natural products and VKA, also because of the critical clinical conditions affecting patients. This is the first step to have the best approach to understand possible INR alterations linked to herb-VKA interaction and to rightly educate patients in treatment with VKA.
Blobel, Bernd; Ruotsalainen, Pekka; Lopez, Diego M; Oemig, Frank
Organizational, methodological and technological paradigm changes enable a precise, personalized, predictive, preventive and participative approach to health and social services supported by multiple actors from different domains at diverse level of knowledge and skills. Interoperability has to advance beyond Information and Communication Technologies (ICT) concerns, including the real world business domains and their processes, but also the individual context of all actors involved. The paper introduces and compares personalized health definitions, summarizes requirements and principles for pHealth systems, and considers intelligent interoperability. It addresses knowledge representation and harmonization, decision intelligence, and usability as crucial issues in pHealth. On this basis, a system-theoretical, ontology-based, policy-driven reference architecture model for open and intelligent pHealth ecosystems and its transformation into an appropriate ICT design and implementation is proposed.
Carlfjord, Siw; Festin, Karin
There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.
Ogden, Jessica; Morrison, Ken; Hardee, Karen
This article recounts the development of a model for social capital building developed over the course of interventions focused on HIV-related stigma and discrimination, safe motherhood and reproductive health. Through further engagement with relevant literature, it explores the nature of social capital and suggests why undertaking such a process can enhance health policy and programmes, advocacy and governance for improved health systems strengthening (HSS) outcomes. The social capital process proposed facilitates the systematic and effective inclusion of community voices in the health policy process-strengthening programme effectiveness as well as health system accountability and governance. Because social capital building facilitates communication and the uptake of new ideas, norms and standards within and between professional communities of practice, it can provide an important mechanism for integration both within and between sectors-a process long considered a 'wicked problem' for health policy-makers. The article argues that the systematic application of social capital building, from bonding through bridging into linking social capital, can greatly enhance the ability of governments and their partners to achieve their HSS goals. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.
Qazi, Muhammad Suleman; Ali, Moazzam
To explore the perceptions of health managers regarding Health Management Information System (HMIS), within their organizational setting and in the context of decentralization process in Pakistan. Owing to the importance of HMIS as a decision making tool and the dependency for its effectiveness on the field-managers who are the key stake holders, a qualitative research was planned to explore, understand, and describe the perceptions of health managers regarding HMIS within their organizational setting in Pakistan. The study was carried out in seven selected districts in all provinces of Pakistan. The strengths highlighted were the sustainability of system even after suspension of funds from donors; vast coverage of over ten thousand health facilities, logistics and drug support systems. The weaknesses included scarcity of resources (i.e. skilled personnel and financial resources), contentious quality and underutilization of data; lack of motivation and feedback among health managers. There is a need to instigate organizational development and institutional strengthening initiatives. These may include defining the structure of organizations; specifying the roles, responsibilities and defining a career structure; managing resources; overhauling the training activity, right from needs assessment to evaluation; creating sense of responsibility; motivating the staff; giving incentives for good work and inculcating work ethics.
Courtney, Paul K
In 2001, the Institute of Medicine report Crossing the Quality Chasm and the National Committee on Vital and Health Statistics report Information for Health were released, and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data are provided to the right person at the right time, which is one definition of "data liquidity." This concept has had some traction in recent years as a shorthand way to express a system property for health information technology, but there is not a well-defined characterization of what properties of a system or of its components give it better or worse data liquidity. This article looks at some recent work that help to identify those properties and perhaps can help to ground the concept with metrics that are assessable.
Abimbola, Seye; Negin, Joel; Martiniuk, Alexandra L; Jan, Stephen
It is important that researchers who study health system governance have a set of collective understandings of the meanings of governance, which can then inform the methods used in research. We present an institutional framing and definition of health system governance; that is, governance refers to making, changing, monitoring and enforcing the rules that govern the demand and supply of health services. This pervasive, relational view of governance is to be preferred to approaches that focus primarily on structures of governments and health care organizations, because health system governance involves communities and service users, and because governments in many low- and middle-income countries tend to under-govern. Therefore, the study of health system governance requires institutional analysis; an approach that focuses not only on structures, but also on the rules (both formal and informal) governing demand and supply relations. Using this 'structure-relations' lens, and based on our field experience, we discuss how this focus could be applied to the three approaches to framing and studying health system governance that we identified in the literature. In order of decreasing focus on structures ('hardware') and increasing focus on relations ('software'), they are: (1) the government-centred approach, which focuses on the role of governments, above or to the exclusion of non-government health system actors; (2) the building-block approach, which focuses on the internal workings of health care organizations, and treats governance as one of the several building blocks of organizations; and (3) the institutional approach, which focuses on how the rules governing social and economic interactions are made, changed, monitored and enforced. Notably, either or both qualitative and quantitative methods may be used by researchers in efforts to incorporate the analysis of how rules determine relations among health system actors into these three approaches to health system
Lifestyle and health status in a sample of Swedish women four years after pregnancy: a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus.
Persson, Margareta; Winkvist, Anna; Mogren, Ingrid
Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/delivery. Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at
A new website and resource library will help improve developing country registration and information systems for vital events. ... This project aims to build ecohealth leadership at the municipal level in Colombia and Venezuela to address health priorities, including vector-borne diseases and food systems interventions for ...
Willis, Cameron D.; Best, Allan; Riley, Barbara; Herbert, Carol P.; Millar, John; Howland, David
Incremental approaches to introducing change in Canada's health systems have not sufficiently improved the quality of services and outcomes. Further progress requires 'large system transformation', considered to be the systematic effort to generate coordinated change across organisations sharing a common vision and goal. This essay draws on…
Full Text Available Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OHD levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OHD level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people ≥75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OHD < 50 nmol/L, in contrast with 49% of orthopedic patients with hip fractures (n = 133, 31% of stroke patients (n = 122, 39% of patients visiting the hospital’s emergency department ≥4 times a year (n = 81, and 75% of homebound adult residents in long-term care nursing homes (n = 51. The mean vitamin D concentration of the healthy control group (74 nmol/L was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (<50 nmol/L. The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.
Pérez-Lu, José E.; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia. Lima, Perú. médico cirujano.; Iguiñiz Romero, Ruth; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia. Lima, Perú.; Bayer, Angela M.; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia. Lima, Perú.; García, Patricia J.; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico.
In developing countries, there are no high quality data to support decision-making and governance due to inadequateinformation collection and transmission processes. Our project WawaRed-Peru: “Reducing health inequities andimproving maternal health by improving health information systems” aims to improve maternal health processes andindicators through the implementation of interoperability standards for maternal health information systems in order fordecision makers to have timely, high quali...
Today it is common to evaluate and compare energy systems in terms of emission of greenhouse gases. However, energy systems should not only reduce their pollution but also give a large energy return. One method used to measure energy efficiency is emergy (embodied energy, energy memory) evaluation, which was developed by the system ecologist Howard T. Odum. Odum defines emergy as the available energy of one kind previously used up directly and indirectly to make a service or product. Both work of nature and work of human economy in generating products and services are calculated in terms of emergy. Work of nature takes the form of natural resources and work of human economy includes labour, services and products used to transform natural resources into something of value to the economy. The quotient between work of nature and work of human economy gives the emergy return on investment of the investigated product. With this in mind the present work is an attempt to make an emergy evaluation of a Swedish nuclear power plant to estimate its emergy return on investment. The emergy return on investment ratio of a Swedish nuclear power plant is calculated to approximately 11 in this diploma thesis. This means that for all emergy the Swedish economy has invested in the nuclear power plant it gets 11 times more emergy in return in the form of electricity generated by nuclear power. The method used in this work may facilitate future emergy evaluations of other energy systems.
Sáenz, María del Rocío; Acosta, Mónica; Muiser, Jorine; Bermúdez, Juan Luis
This paper describes the Costa Rican health system which provides health, water and sanitation services. The health component of the system includes a public and a private sector. The public sector is dominated by the Caja Costarricense de Seguro Social (CCSS), an autonomous institution in charge of financing, purchasing and delivering most of the personal health services in Costa Rica. CCSS is financed with contributions of the affiliates, employers and the state, and manages three regimes: maternity and illness insurance, disability, old age and death insurance, and a non-contributive regime. CCSS provides services in its own facilities but also contracts with private providers. The private sector includes a broad set of services offering ambulatory and hospital care. These services are financed mostly out-of-pocket, but also with private insurance premiums. The Ministry of Health is the steward of the system, in charge of strategic planning, sanitary regulation, and research and technology development. Among the recent policy innovations we can mention the establishment of the basic teams for comprehensive health care (EBAIS), the de-concentration of hospitals and public clinics, the introduction of management agreements and the creation of the Health Boards.
Racine, Andrew D
The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights
Full Text Available Abstract Recent developments, including experience related to the development of WHO's World Health Report 2001, the WHO Atlas and the DCP Project related to Mental, Neurological, Developmental and Substance Abuse Disorders, indicate why advancing the interests of mental health is now so compelling. In order to deliver a high standard of mental health treatment and care WHO emphasizes the adoption of an integrated system of service delivery to address comprehensively the psychosocial needs of people with mental disorders. Even though the burden is large and increasing, the capacity to reach those in need is poor. This gap cannot be filled just by seeking more funding for mental health, more human resources, or more training. Of course, these aspects are key ingredients but what is often neglected is the need to conceive service delivery rationally. Mental health professionals' attention should be channeled towards mental health systems and service organization which obviously has consequences in their training which should include more public health knowledge. We need to know how to plan and organize services and improve the use of scarce financial and human resources in order to reach out to the mental health needs of the general population and to provide effective and humane services to those who need care.
Arvidsson, Anna; Johnsdotter, Sara; Essén, Birgitta
Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.
Full Text Available Information Technologies are disruptive technologies that have caused major changes in health system in Poland. Current digital economy is driven by modern information and new IT tools, which offer hospitals, doctors and patient access to any type of information, regardless of its form of existence, storage type or geographical location. These tools encourage the development of new activities, health services. The purpose of this article is to analyze the the current state of development of e-services in Poland in the context of nowadays health system. In the first part of the paper, the authors present various programmes, which enable the access to the medical services and patients’ data online. The next part of the paper is devoted to examining the technical aspects of the said programmes and presenting their advantages as well as the areas which might be improved.The last part of the work will be focused on the websites of the selected health institutions. According to the authors, WWW services provide much information on how the process of computer systems are being implemented, what data the services include and the capacity of the equipment as well as the software, human resources and the knowledge in this sphere. Moreover this section highlights the latest trends in e-health with particular emphasis on aspects such as the use of private and public cloud computer and t heir integration with web sites of health institutions. This study brings its contribution to the understanding of the change of health system in Poland behavior by using a new perspective e-health systems and IT tools above by doctors, officers and patients.
Margolis, Karen L; Mucci, Lorelei; Braaten, Tonje; Kumle, Merethe; Trolle Lagerros, Ylva; Adami, Hans-Olov; Lund, Eiliv; Weiderpass, Elisabete
Physical activity has been found to be associated with decreased risk of breast cancer in postmenopausal women in the majority of epidemiologic studies, but the association is inconsistent in premenopausal women. We studied the effect of physical activity at various ages on the incidence of breast cancer in 99,504 women from 30 to 49 years of age at enrollment in the Women's Lifestyle and Health Study, a prospective population-based cohort study in Norway and Sweden. Physical activity level on an ordinal scale at age 14, age 30, and age at enrollment, participation in competitive sports, as well as information on other covariates was obtained using a self-administered questionnaire. Complete follow-up with data on incident invasive breast cancer and mortality was collected by linkage to national registries. The relation between physical activity and time to breast cancer development was assessed using Cox proportional hazard models, controlling for potential confounders. During an average 9.1 years of follow-up, there were 1,166 incident breast cancer cases. The mean age of the women was 41 years at enrollment, and the mean age at breast cancer diagnosis was 48 years. Compared to inactive women, women with higher levels of physical activity at enrollment had a similar risk of incident breast cancer (adjusted relative risk, 1.24 for vigorous activity compared with no activity; 95% CI, 0.85-1.82). Physical activity at age 30 or at age 14 also did not afford any significant protection from breast cancer, nor did a consistently high level of activity from younger ages to enrollment. We did not find evidence of a protective effect of physical activity on breast cancer risk in this group of primarily premenopausal women.
Stucki, Gerold; Bickenbach, Jerome; Melvin, John
A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.
Strömqvist, Björn; Fritzell, Peter; Hägg, Olle; Jönsson, Bo
The Swedish Spine Register enables monitoring of surgical activities focusing on changes in trends over time, techniques utilized and outcome, when implemented in general clinical practice. Basic requirements for a prosperous register are unity within the profession, mainly patient-based documentation and a well functioning support system. This presentation focuses on the development and design of the register protocol, problems encountered and solutions found underway. Various examples on ho...
Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S
Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it.
Pérez-Lu, José E; Iguiñiz Romero, Ruth; Bayer, Angela M; García, Patricia J
In developing countries, there are no high quality data to support decision-making and governance due to inadequate information collection and transmission processes. Our project WawaRed-Peru: "Reducing health inequities and improving maternal health by improving health information systems" aims to improve maternal health processes and indicators through the implementation of interoperability standards for maternal health information systems in order for decision makers to have timely, high quality information. Through this project, we hope to support the development of better health policies and to also contribute to reducing problems of health equity among Peruvian women and potentially women in other developing countries. The aim of this article is to present the current state of information systems for maternal health in Peru.
Vlad, R.S.; Petersen, P.E.
Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life......Attitudes, dental status, socioeconomic factors, oral health care, production of oral health, health status, quality of life...
Background: In a time of growing health expenditures and inefficiencies, ageing populations, rise of chronic diseases, co-morbity and technical evolutions, there is a worldwide quest for performant, innovative and sustainable health systems that are, a.o. effective and cost-efficient, patient-centric and co-creative and able to deal with the growing society dynamics.Problem statement: Effectively implementing strategic initiatives that tackle these challenges appears a frightening task since ...
Gustafsson, Daniel Marcus Sunil
This paper discusses different gender aspects of the Swedish Armed Forces with specific references to sexual harassment and prostitution. By using the concept of Hegemonic Masculinity, sexual harassment of the women in the Swedish Armed Forces is explained in terms of a need of the men within...... the organisation to reinforce the notion of women as inferior and subordinate to men, whereby the external hegemony is believed to be restored. Likewise, male Swedish peacekeepers’ demand for prostitution during international peacekeeping missions is explained in terms of a need to confirm manhood and as homo...
Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.
Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.
Hanney, Stephen R; González-Block, Miguel A
In 1627, Francis Bacon's New Atlantis described a utopian society in which an embryonic research system contributed to meeting the needs of the society. In this editorial, we use some of the aspirations described in New Atlantis to provide a context within which to consider recent progress in building health research systems to improve health systems and population health. In particular, we reflect on efforts to build research capacity, link research to policy, identify the wider impacts made by the science, and generally build fully functioning research systems to address the needs identified. In 2014, Health Research Policy and Systems has continued to publish one-off papers and article collections covering a range of these issues in both high income countries and low- and middle-income countries. Analysis of these contributions, in the context of some earlier ones, is brought together to identify achievements, challenges and possible ways forward. We show how 2014 is likely to be a pivotal year in the development of ways to assess the impact of health research on policies, practice, health systems, population health, and economic benefits.We demonstrate how the increasing focus on health research systems will contribute to realising the hopes expressed in the World Health Report, 2013, namely that all nations would take a systematic approach to evaluating the outputs and applications resulting from their research investment.
Junuzovic, Mensura; Midlöv, Patrik; Lönn, Sara Larsson; Eriksson, Anders
Since any firearm injury is potentially lethal, it is of great interest to prevent firearm incidents. This study investigated such incidents during hunting and Swedish hunters' safety behaviour. A 48-item questionnaire was posted to a random sample of 1000 members of the Swedish Association for Hunting and Wildlife Management. The questions considered demographics, hunting experience/hunting habits/safety behaviour/attitudes and experience of careless weapon handling, hunters' weapons and safety behaviour relating to weapons, health status, firearm incidents and their preventability, and personal comments on the questionnaire. The response rate was almost 50%. The mean age of the responders was 54 years; 5% were females. Almost none (1%) reported hunting under the influence of alcohol. Young age and male sex were positively associated with risk behaviour, although the presence of multiple risk behaviours in the same responder was not common. A very high degree of compliance with Swedish laws regarding weapon storage was reported. One-quarter of the responders had witnessed a firearm incident caused by another hunter, which in most situations did not result in human injury or death. An unsafetied weapon was the most common reported "cause" of these incidents. Experience of a firearm incident was not uncommon and the majority of the responders considered the incident in question to be preventable. This study provides a picture of the possible risk behaviour among hunters and the results suggest that future prevention work should target safer weapon handling. Copyright © 2013 Elsevier Ltd. All rights reserved.
Forsell, Karl; Eriksson, Helena; Järvholm, Bengt; Lundh, Monica; Andersson, Eva; Nilsson, Ralph
To get knowledge of the work environment for seafarers sailing under the Swedish flag, in terms of safety climate, ergonomical, chemical and psychosocial exposures, and the seafarers self-rated health and work ability. A Web-based questionnaire was sent to all seafarers with a personal e-mail address in the Swedish Maritime Registry (N = 5608). Comparisons were made mainly within the study population, using Student's t test, prevalence odds ratios and logistic regressions with 95% confidence intervals. The response rate was 35% (N = 1972; 10% women, 90% men), with 61% of the respondents working on deck, 31% in the engine room and 7% in the catering/service department (1% not classifiable). Strain on neck, arm or back and heavy lifting were associated with female gender (p = 0.0001) and younger age (below or above 30 years of age, p work problems were noise, risk of an accident and vibrations from the hull of the ship. The safety climate was high in comparison with that in land-based occupations. One-fourth had experienced personal harassment or bullying during last year of service. Noise, risk of accidents, hand/arm and whole-body vibrations and psychosocial factors such as harassment were commonly reported work environment problems among seafarers within the Swedish merchant fleet.
Courtney, Paul K
In 2001 the IOM report "Crossing the Quality Chasm" and the NCVHS report "Information for Health" were released and they provided the context for the development of information systems used to support health-supporting processes. Both had as their goals, implicit or explicit, to ensure the right data is provided to the right person at the right time, which is one definition of "Data Liquidity". This concept has had some traction in recent years as a shorthand way to express a system property ...
Full Text Available Introduction: The international financial situation in combination with an aging population and the appropriation of health services imposes the management of hospital services as a necessity for the survival of hospitals.Aim: To examine the perceptions of 450 upper administrative hospital executives (Nursing, Medicine and Administrative services in the wider region of Attica, on marketing, communication, and public relations in health-care.Population study: Four hundred and fifty (450 higher health executives from the three basic fields of services in health institutions (medical, nursing, administration constituted the total sample of the research. These people are employed at 9 of the 36 hospitals in the 3 Health Regions of Attica (H.Re.Materials and method:The type of design that was chosen (to gather data for the study of attitudes and perceptions of the health personnel of the health institutions of G.S.H (Greek System of Health is a cross- sectional survey.Results: The participating subjects, even though expressed some reservations at first, formed a favorable attitude towards marketing and its application in the field of health-care. Statistically important correlations emerged between the perceptions of executives and their socio-demographic background including age, sex, education, and profession, work experience in health-care and specifically in their current position in the services as well as statistically important differences between doctors, nurses and administrators as to their perceptions of some issues in marketing.Conclusions: From the comments in the survey it appears there is a need to apply marketing correctly when providing quality care, respecting the patients’ rights and using human and not financial criteria as a guide. Based on the results of the research, important proposals are being submitted in the areas of health-care research, education and clinical practice.
Carlsson, My; Holmström, David; Bohn, Irene; Bisaillon, Mattias; Morgan-Sagastume, Fernando; Lagerkvist, Anders
Several methods for physical pre-treatments of source sorted organic fraction of municipal solid waste (SSOFMSW) before for anaerobic digestion (AD) are available, with the common feature that they generate a homogeneous slurry for AD and a dry refuse fraction for incineration. The selection of efficient methods relies on improved understanding of how the pre-treatment impacts on the separation and on the slurry's AD. The aim of this study was to evaluate the impact of the performance of physical pre-treatment of SSOFMSW on greenhouse-gas (GHG) emissions and on the economy of an AD system including a biogas plant with supplementary systems for heat and power production in Sweden. Based on the performance of selected Swedish facilities, as well as chemical analyses and BMP tests of slurry and refuse, the computer-based evaluation tool ORWARE was improved as to accurately describe mass flows through the physical pre-treatment and anaerobic degradation. The environmental and economic performance of the evaluated system was influenced by the TS concentration in the slurry, as well as the distribution of incoming solids between slurry and refuse. The focus to improve the efficiency of these systems should primarily be directed towards minimising the water addition in the pre-treatment provided that this slurry can still be efficiently digested. Second, the amount of refuse should be minimised, while keeping a good quality of the slurry. Electricity use/generation has high impact on GHG emissions and the results of the study are sensitive to assumptions of marginal electricity and of electricity use in the pre-treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.
Forsberg, Anna; Lennerling, Annette; Fridh, Isabell; Rizell, Magnus; Lovén, Charlotte; Flodén, Anne
To explore the attitudes of Swedish intensive care nurses towards organ donor advocacy. The concept of organ donor advocacy is critical to nurses who care for potential donors in order to facilitate organ donation (OD). A retrospective cross-sectional study was employed. Inclusion criteria in this survey were to be a registered nurse and to work in a Swedish intensive care unit (ICU). Participants were identified by the Swedish association of health professionals. A number of 502 Swedish ICU nurses answered the 32-item questionnaire Attitudes Towards Organ Donor Advocacy Scale (ATODAS), covering the five dimensions of organ donor advocacy: attitudes towards championing organ donation at a structural hospital level, or at a political and research level, attitudes towards actively and personally safeguarding the will and wishes of the potential organ donor, or by using a more professional approach and finally to safeguard the will and wishes of the relatives. Data were analysed with the SPSS version 18·0 and the results were assessed by using Student's t-test and post hoc test, analysis of variance (ANOVA), χ(2) , Pearson's correlation and regression analysis. The most favoured advocacy action was safeguarding the POD's will and wishes by a professional approach, closely followed by actively and personally safeguarding the POD's will and wishes. Nurses at local hospitals reported a more positive attitude towards organ donor advocacy overall compared with nurses at larger regional or university hospitals. Important factors leading to positive attitudes were seniority, working experience, participating in conversations with relatives, caring for brain-dead persons and private experiences from OD or organ transplantation. Intensive and critical care nurses with short working experience in university hospitals showed the least positive attitude towards organ donor advocacy. This is problematic because many ODs and all transplantations are performed in university
Rosenälv, Jessica; Lundell, Karl-Henrik
"We need a precise framework of regulations in order to maintain appropriate and structured health care documentation that ensures that the information maintains a sufficient level of quality to be used in treatment, in research and by the actual patient. The users shall be aided by clearly and uniformly defined terms and concepts, and there should be an information structure that clarifies what to document and how to make the information more useful. Most of all, we need to standardize the information, not just the technical systems." (eHälsa - nytta och näring, Riksdag report 2011/12:RFR5, p. 37). In 2010, the Swedish Government adopted the National e-Health - the national strategy for accessible and secure information in healthcare. The strategy is a revision and extension of the previous strategy from 2006, which was used as input for the most recent efforts to develop a national information structure utilizing business-oriented generic models. A national decision on healthcare informatics standards was made by the Swedish County Councils, which decided to follow and use EN/ISO 13606 as a standard for the development of a universally applicable information structure, including archetypes and templates. The overall aim of the Swedish strategy for development of National Healthcare Information Architecture is to achieve high level semantic interoperability for clinical content and clinical contexts. High level semantic interoperability requires consistently structured clinical data and other types of data with coherent traceability to be mapped to reference clinical models. Archetypes that are formal definitions of the clinical and demographic concepts and some administrative data were developed. Each archetype describes the information structure and content of overarching core clinical concepts. Information that is defined in archetypes should be used for different purposes. Generic clinical process model was made concrete and analyzed. For each decision
Holmberg, Soeren; Hedberg, Per
the 1970s, energy production was politicized big time in the industrialized world. The birth of the environmental movement, the oil crises in 1973 - 74 and the beginning conflict surrounding civilian nuclear power, put energy issues center stage on the political agenda. Energy policies - especially related to the development of nuclear power - came to dominate election campaigns, like in Sweden in 1976 or be the subject of referendums, like in Austria in 1978 or in Sweden in 1980. Critical voices toward the peaceful use of nuclear power - having started in America before being exported to Europe - gained real strength and public support all over the Western world by the nuclear accident at the Three Mile Island plant in Harrisburg, Pennsylvania in 1979. The energy genie was out of the bottle and out to stay. Fueled by the nuclear meltdowns in Chernobyl in 1986 and in Fukushima in 2011 and supplemented by conflicts over how to reduce the use of oil and coal, how to sensibly exploit the waste gas reserves, and how to develop renewable energy sources based on sun, wind and waves – have made all kinds of energy issues the focal point of political contentions ever since the early 1970s. In Sweden, as in many other countries, energy policies - often with nuclear power in the center - have been one of the most fought-over policy areas during the last thirty-forty years. And the contentious character of energy policies is not limited to the elite level of politics - to politicians, to media pundits or to lobbyists. It is also manifest among ordinary citizens. Energy issues - nuclear power and wind power in particular - are highly polarizing among voters as well. Given this historic background, starting in the 1970s, it was rather natural that energy questions - featuring most prominently questions related to nuclear power - would be important parts of the voter surveys performed by the Swedish National Elections Studies (SNES) at the Univ. of Gothenburg. The first book
H. Zhang (Hao)
markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect
Ludvigsson, Jonas F; Otterblad-Olausson, Petra; Pettersson, Birgitta U.; Ekbom, Anders
Swedish health care and national health registers are dependent on the presence of a unique identifier. This paper describes the Swedish personal identity number (PIN) and explores ethical issues of its use in medical research. A ten-digit-PIN is maintained by the National Tax Board for all individuals that have resided in Sweden since 1947. Until January 2008, an estimated 75,638 individuals have changed PIN. The most common reasons for change of PIN are incorrect recording of date of birth ...
Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim
A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.
Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.
This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to
Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin
The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.
Health system performance measurement is a ubiquitous phenomenon. Many authors have identified multiple methodological and substantive problems with performance measurement practices. Despite the validity of these criticisms and their cross-national character, the practice of health system performance measurement persists. Theodore Marmor suggests that performance measurement invokes an "incantatory response" wrapped within "linguistic muddle." In this article, I expand upon Marmor's insights using Pierre Bourdieu's theoretical framework to suggest that, far from an aberration, the "linguistic muddle" identified by Marmor is an indicator of a broad struggle about the representation and classification of public health services as a public good. I present a case study of performance measurement from Alberta, Canada, examining how this representational struggle occurs and what the stakes are. © The Author(s) 2015.
Mengiste, Shegaw Anagaw; Neilsen, Petter
specifically, we question the fruitfulness of focusing on not being installed base hostile and suggest focusing on how to be installed base “friendly” by underscoring how the installed base can also be draw upon and shaped by human agents. The paper conceptualizes health information infrastructure (HII......This article addresses the issues of scaling health information system in the context of developing countries by taking a case study from Ethiopia. Concepts of information infrastructure have been used as an analytical lens to better understand scaling of Health Information systems. More...... to the installed base. The relative strength between the proponents of a HIS and the installed base will vary and thus require different approaches. While the II may develop and evolve as it is out of control from time to time, this study shows that there is also room for II building activities at certain points...
Loberg, B. E. H.; Horndahl, A.-K.
Chemical analysis for major and trace elements have been performed on 30 Swedish Precambrian iron ores and on some from Iran and Chile. The Swedish ores consist of apatite iron ores, quartz-banded iron ores, skarn and limestone iron ores from the two main ore districts of Sweden, the Bergslagen and the Norrbotten province. Some Swedish titaniferous iron ores were also included in the investigation. The trace element data show that the Swedish ores can be subdivided into two major groups: 1. orthomagmatic and exhalative, 2. sedimentary. Within group 1 the titaniferous iron ores are distinguished by their high Ti-contents. From the ferride contents of the Kiruna apatite iron ores, the ores are considered to be mobilization products of skarn iron ores from the Norbotten province.
Azétsop, Jacquineau; Ochieng, Michael
There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded
Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.
Figueroa, Fernando; Schmalzel, John
Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.
Full Text Available Peter Tsasis,1 Jenna M Evans,2 David Forrest,3 Richard Keith Jones4 1School of Health Policy and Management, Faculty of Health, York University, Toronto, Canada; 2Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Canada; 3Global Vision Consulting Ltd, Victoria, Canada; 4R Keith Jones and Associates, Victoria, Canada Abstract: Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care. Keywords: integrated care, integrated delivery systems, complex adaptive systems, social capital
Oresland, S; Jakobsson, A; Segesten, K
In order to examine the perceptions of sex equality among medical doctors (MDs) and registered nurses (RNs), a survey was conducted in a Swedish University Hospital in May 1995. A questionnaire was sent to 475 MDs and RNs of three different age groups. The results showed that women tend to have similar opinions irrespective of occupation and age, which differed significantly from those of men. Men believed that equality in general exists in the hospital, while women think the values and conditions in the workplace mainly benefit men. No evidence was found to indicate a change in the sex hierarchy within the health care system. Rather, the status quo will be maintained and gender stereotypes reinforced from one generation to the next.
Neff, Roni A; Parker, Cindy L; Kirschenmann, Frederick L; Tinch, Jennifer; Lawrence, Robert S
Peak oil is the phenomenon whereby global oil supplies will peak, then decline, with extraction growing increasingly costly. Today's globalized industrial food system depends on oil for fueling farm machinery, producing pesticides, and transporting goods. Biofuels production links oil prices to food prices. We examined food system vulnerability to rising oil prices and the public health consequences. In the short term, high food prices harm food security and equity. Over time, high prices will force the entire food system to adapt. Strong preparation and advance investment may mitigate the extent of dislocation and hunger. Certain social and policy changes could smooth adaptation; public health has an essential role in promoting a proactive, smart, and equitable transition that increases resilience and enables adequate food for all.
2004 was somewhat of a record year for the Swedish nuclear power stations. No serious faults occurred, and production exceeded previous record outputs. Total output from the eleven nuclear power units during the year amounted to 75 TWh, which is the largest amount of power ever produced by nuclear power in Sweden. Corresponding figures for earlier years are 59 TWh (2003), 65 TWh (2002) and 69 TWh (2001). An important reason for this excellent result was the very high energy availability. Forsmark 1, for example, exceeded 97 % availability, while Forsmark 2 just reached 97 %. For all the Swedish nuclear power stations as a whole, availability in 2004 amounted to 91 %. In addition to the connection between production and energy availability, there is also a connection with safety. During the year, safety in the Swedish power stations has been high, not only in absolute terms but also in an international perspective. One measure of safety is to be found in the number of accidents, incidents, anomalies or deviations reported to the IAEA on a scale known as the International Nuclear Event Scale (INES). Sweden has undertaken to report all events in accordance with this international system. Three reports were submitted by the Swedish Nuclear Power Inspectorate, which is responsible for national reporting, during the year. None of them had any significance for reactor safety: all were categorised as incidents or minor deviations from the regulations. Summarising, 2004 has been an excellent year for nuclear power safety, which is also reflected by the record electricity production during the year.
Full Text Available This paper provides a detailed representational analysis of the morpho-prosodic system of underived nouns in a dialect of Swedish. It shows that the morphology, stress and tonal patterns are not as complex as they first appear once the data are looked at in sufficient detail. Further, it shows that the renowned Swedish "lexical pitch accent" is not the result of lexical tones/tonemes. Rather, Swedish is like all other languages and uses tones to mark the edges of prosodic constituents on the surface. "Accent 2" occurs when tones mark the edge of a structural uneven trochee (i.e. recursive foot and "accent 1" occurs elsewhere. This analysis is counter all other treatments of North Germanic tones and denies the almost unquestioned assumption that there is an underlying tone specification on roots and/or affixes in many North Germanic varieties. At the same time, it unifies the intuitions behind the three previous approaches found in the literature.
24 juin 2015 ... Researchers with the Africa Health Systems Initiative (AHSI) have uncovered ways to strengthen health systems in sub-Saharan Africa. Weak health systems cause a high burden of preventable and treatable illnesses, especially for those living in rural areas. Strong health systems are needed to provide ...
Therefore, in-service training and updating of staff involved in health information system (HIS) at district, strengthening health information system inputs, timely and concrete feedbacks with establishment of functional health management information system (HMIS). KEY WORDS: Health Management Information System, ...
Luis Ricardo Bernardo
Full Text Available According to recent technology road maps, system cost reductions and development of standardised plug-and-function systems are some of the most important goals for solar heating technology development. Retrofitting hot water boilers in single-family houses when installing solar collectors has the potential to significantly reduce both material and installation costs. Previous studies have investigated such retrofitting, using theoretical simulations and laboratory tests, but no actual installations were made and tested in practice. This article describes the installation, measured performance and cost effectiveness of a retrofitting solution that converts existing domestic hot water heaters to a solar domestic hot water system. The measured performance is characterised by the monthly and annual solar fractions. The cost effectiveness is evaluated by a life-cycle cost analysis, comparing the retrofitted system to a conventional solar domestic hot water system and the case without any solar heating system. Measurements showed that approximately 50% of the 5000 kWh/year of domestic hot water consumption was saved by the retrofitted system in south Sweden. Such savings are in agreement with previous estimations and are comparable to the energy savings when using a conventional solar domestic hot water system. The life-cycle cost analysis showed that, according to the assumptions and given climate, the return on investment of the retrofitted system is approximately 17 years, while a conventional system does not reach profitability during its lifetime of 25 years.
Zidar, Maria Norfjord; Larm, Peter; Tillgren, Per; Akhavan, Sharareh
Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance. The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county's municipalities, aggregated data for women in the age range 40-74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests. The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening. Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care
Rao, Krishna D; Arora, Radhika; Ghaffar, Abdul
Research on health systems is an important contributor to improving health system performance. Importantly, research on program and policy implementation can also create a culture of public accountability. In the last decade, significant health system reforms have been implemented in India. These include strengthening the public sector health system through the National Rural Health Mission (NRHM), and expansion of government-sponsored insurance schemes for the poor. This paper provides a situation analysis of health systems research during the reform period. We reviewed 9,477 publications between 2005 and 2013 in two online databases, PubMed and IndMED. Articles were classified according to the WHO classification of health systems building blocks. Our findings indicate the number of publications on health systems progressively increased every year from 92 in 2006 to 314 in 2012. The majority of papers were on service delivery (40%), with fewer on information (16%), medical technology and vaccines (15%), human resources (11%), governance (5%), and financing (8%). Around 70% of articles were lead by an author based in India, the majority by authors located in only four states. Several states, particularly in eastern and northeastern India, did not have a single paper published by a lead author located in a local institution. Moreover, many of these states were not the subject of a single published paper. Further, a few select institutions produced the bulk of research. Of the foreign author lead papers, 77% came from five countries (USA, UK, Canada, Australia, and Switzerland). The growth of published research during the reform period in India is a positive development. However, bulk of this research is produced in a few states and by a few select institutions Further strengthening health systems research requires attention to neglected health systems domains like human resources, financing, and governance. Importantly, research capacity needs to be strengthened in
The aim of this report is to describe and analyze the embodiment of acceptance and recognition in discourses and practices which address cultural diversity in the Swedish educational system. In order to fulfil this general aim, we study how different categories of practitioners in the Swedish school system, such as teachers, headmasters and union representatives, and other stakeholders, such as civil servants, and representatives of political parties and the civil society, discuss and relate ...
Carney, Timothy Jay; Kong, Amanda Y
Informaticians are challenged to design health information technology (IT) solutions for complex problems, such as health disparities, but are achieving mixed results in demonstrating a direct impact on health outcomes. This presentation of collective intelligence and the corresponding terms of smart health, knowledge ecosystem, enhanced health disparities informatics capacities, knowledge exchange, big-data, and situational awareness are a means of demonstrating the complex challenges informatics professionals face in trying to model, measure, and manage an intelligent and smart systems response to health disparities. A critical piece in our understanding of collective intelligence for public and population health rests in our understanding of public and population health as a living and evolving network of individuals, organizations, and resources. This discussion represents a step in advancing the conversation of what a smart response to health disparities should represent and how informatics can drive the design of intelligent systems to assist in eliminating health disparities and achieving health equity. Copyright © 2017. Published by Elsevier Inc.
Mengiste, Shegaw Anagaw; Kimaro, Honest; Aanestad, Margunn
Despite widespread aims to strengthen the Health