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- Barber, R. M., et al.
(författare)
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Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
- 2017
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Ingår i: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
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Tidskriftsartikel (refereegranskat)abstract
- Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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| 5. |
- Edquist, Samuel
(författare)
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I Ruriks fotspår : Om forntida svenska österledsfärder i modern historieskrivning
- 2012. - 1
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Bok (refereegranskat)abstract
- Vikingatiden finns överallt: läktarna fylls av vikingahjälmar när det är landskamp, runtomkring i Sverige grundas vikingabyar, och i vår alltmer kommersialiserade historiekultur hävdas att vikingaarvet ska hjälpa oss att locka turister till Sverige. Vikingatiden är också ideologiskt laddad som få historiska epoker. Den har setts som en period när Sverige på allvar framträdde som ett eget rike, och när svenskarna för första gången gjorde sig bemärkta i andra länder. Inte minst for de österut, och tack vare arkeologiska fynd och 1100-talsskriften Nestorskrönikan har lärda och vetenskapsmän i Sverige och andra länder hävdat att Ryssland grundats av svenskar.I boken I Ruriks fotspår: Om forntida svenska österledsfärder i modern historieskrivning studerar historikern Samuel Edquist hur skandinavernas vikingafärder i österled beskrivits av svenska forskare igår och idag. Vi får följa utvecklingen från 1800-talets besatthet vid att finna ursprunget till våra tiders nationer i forntiden, och hur denna nationalism genomsyrade forskningsresultaten, till våra dagars försök att göra upp med vetenskapens nationalistiska förflutna. Studien avslutas med en diskussion om tänkbara strategier för att förhålla sig till en så ideologiskt laddad företeelse som vikingatiden.
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| 6. |
- Edquist, Samuel, et al.
(författare)
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Islands of Identity : History-writing and identity formation in five island regions in the Baltic Sea
- 2015. - 1
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Bok (refereegranskat)abstract
- Gotland, Åland, Saaremaa, Hiiumaa and Bornholm are five island regions in the Baltic Sea which constitute, or have until recently constituted, provinces or counties of their own. Combining perspectives from two disparate academic fields, uses of history and island studies, this book investigates how regional history writing has contributed to the formation of regional identity on these islands since the year 1800. The special geographic situation of the islands-somewhat secluded from the mainland but also connected to important waterways-has provided their inhabitants with shared historical experiences. Due to varying geographic and historical circumstances, the relationship between regional and national identity is however different on each island. While regional history writing has in most cases aimed at integrating the island into the nation state, it has on Åland in the second half of the 20th century been used to portray its inhabitants as a separate nation. Dramatic political upheavals as the World Wars has also caused shifts in how regional history writing has represented the relationship to the mainland nation state, and has sometimes also resulted in altered national loyalties.
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| 7. |
- Edquist, Samuel, 1973-
(författare)
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Nyktra svenskar : Godtemplarrörelsen och den nationella identiteten 1879–1918
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is the spread of nationalist ideology in the Good Templar movement – one of the largest mass organisations in Sweden in the decades preceding the introduction of universal suffrage following World War One. This temperance organisation had many significant ideological functions. It was an important arena of integration for Liberal and Social Democrat politicians, a pioneer of popular education, and a significant organiser of leisure activities. It is argued that the nationalist ideology in the Good Templar movement was particularly important in reproducing a bourgeois hegemony in Sweden. In opposing the nationalism of the conservatives, liberals and most socialists advocated a national ideology for a new and democratic Sweden. They idealised the ‘people’ of the popular movements in political issues, in the writing of history, and with the spread of folklore. At the same time, this ideology integrated workers, small farmers, schoolteachers etc. into a homogeneous group – the ‘people’, i.e. the nucleus of the nation. Much of this nationalism was considered to be politically neutral, and part of a cultural heritage that was supposed to be spread to the population. Through the consistent singing of the national anthem at the end of the temperance meeting, and through the ritual flying of the flag at larger gatherings, a general national ideology was disseminated. This nationalism was largely shared by socialists and non-socialists, with the purpose of creating consent to the parliamentary, bourgeois-democratic state. The nationalism of the Good Templars was largely cultural rather than civic. Especially after 1900, the folkloristic element of the movement was substantial. In many ways the temperance movement was the principal agent in making folk dances, folk games, and ritual meetings in the outdoors typical elements of Swedish nationalism.
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- Hammarström, Per, 1960-
(författare)
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Nationens styvbarn : Judisk samhällsintegration i några Norrlandsstäder 1870-1940
- 2007
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Ingår i: Svensk kyrkotidning. - Stockholm : Carlsson Bokförlag. - 0346-2153. ; :51-52, s. 664-
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna avhandling är att undersöka vilken ekonomisk och social ställning den judiska minoriteten intog i det svenska samhället under perioden 1870 till 1940. Tidigare forskning har riktat stor uppmärksamhet mot rättsliga och politiska aspekter av den svenska judenhetens historia, mer sällan mot judarna och samhället i en bredare bemärkelse. Andra studier har lyft fram antisemitism på svensk mark utan att koppla fenomenet till en social nivå.Genom en undersökning av hur judiska invandrare, med ursprung i Östeuropa, successivt fogades in i några svenska lokalsamhällen, tar denna avhandling ett bredare grepp på frågan om judarna och samhället. Här undersöks hur den svenska judenheten integrerades i samhället efter det att emancipationen gett judarna fulla medborgerliga och politiska rättigheter. Judarnas ekonomiska och sociala ställning undersöks, liksom den sociala antisemitism som drabbade judarna. Studien rör sig i gränslandet mellan social- och kulturhistoria. Undersökningen visar att merparten av judarna i Sundsvall, en betydelsefull handelsstad i norra Sverige, fick sin försörjning genom en föga lönsam gårdfarihandel under början av undersökningsperioden. Sedan butiks- och grosshandelsrörelser började grundas inleddes en långsam socioekonomisk klättring. I takt med de ekonomiska framgångarna ökade judarnas sociala status, med engagemang i föreningslivet och lokalpolitiken. De framgångsrika familjerna tonade ner sin judiska identitet till förmån för en borgerlig och nationell kultur.Ungefär hälften av den judiska gruppen fick aldrig uppleva framgången utan förblev en marginaliserad grupp, med småhantverk eller gårdfarihandel som försörjningsbas. Det stora flertalet av denna underklass saknade svenskt medborgarskap. En social klyfta vidgades gentemot den judiska borgerligheten. Under hela undersökningsperioden var antisemitismen en kulturell kod i majoritetssamhället, oavsett integration och socioekonomisk framgång. Mycket tyder på att det sociala klimatet blev mer fientligt gentemot judarna efter 1920. Studien visar att nationalstaten Sverige lämnade litet utrymme för multikulturella strukturer. Judarna accepterades som nationens styvbarn men knappast som fullvärdiga svenskar.
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| 10. |
- Laukka, Petri, et al.
(författare)
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Neurofunctional correlates of expressed vocal affect in social phobia
- 2011
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Ingår i: Cognitive, Affective, & Behavioral Neuroscience. - : Springer Science and Business Media LLC. - 1530-7026 .- 1531-135X. ; 11:3, s. 413-425
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the neural correlates of expressed vocal affect in patients with social phobia. A group of 36 patients performed an anxiogenic public-speaking task while regional cerebral blood flow (rCBF) was assessed using oxygen-15 positron emission tomography. The patients’ speech was recorded and content masked using low-pass filtering (which obscures linguistic content but preserves nonverbal affective cues). The content-masked speech samples were then evaluated with regard to their level of vocally expressed nervousness. We hypothesized that activity in prefrontal and subcortical brain areas previously implicated in emotion regulation would be associated with the degree of expressed vocal affect. Regression analyses accordingly revealed significant negative correlations between expressed vocal affect and rCBF in inferior frontal gyrus, putamen, and hippocampus. Further, functional connectivity was revealed between inferior frontal gyrus and (a) anterior cingulate cortex and (b) amygdala and basal ganglia. We suggest that brain areas important for emotion regulation may also form part of a network associated with the modulation of affective prosody in social phobia.
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