| 1. |
- Bergqvist, Kersti, et al.
(författare)
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Understanding the role of welfare state characteristics for health and inequalities - an analytical review
- 2013
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13, s. 1234-
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Forskningsöversikt (refereegranskat)abstract
- Background: The past decade has witnessed a growing body of research on welfare state characteristics and health inequalities but the picture is, despite this, inconsistent. We aim to review this research by focusing on theoretical and methodological differences between studies that at least in part may lead to these mixed findings. Methods: Three reviews and relevant bibliographies were manually explored in order to find studies for the review. Related articles were searched for in PubMed, Web of Science and Google Scholar. Database searches were done in PubMed and Web of Science. The search period was restricted to 2005-01-01 to 2013-02-28. Fifty-four studies met the inclusion criteria. Results: Three main approaches to comparative welfare state research are identified; the Regime approach, the Institutional approach, and the Expenditure approach. The Regime approach is the most common and regardless of the empirical regime theory employed and the amendments made to these, results are diverse and contradictory. When stratifying studies according to other features, not much added clarity is achieved. The Institutional approach shows more consistent results; generous policies and benefits seem to be associated with health in a positive way for all people in a population, not only those who are directly affected or targeted. The Expenditure approach finds that social and health spending is associated with increased levels of health and smaller health inequalities in one way or another but the studies are few in numbers making it somewhat difficult to get coherent results. Conclusions: Based on earlier reviews and our results we suggest that future research should focus less on welfare regimes and health inequalities and more on a multitude of different types of studies, including larger analyses of social spending and social rights in various policy areas and how these are linked to health in different social strata. But, we also need more detailed evaluation of specific programmes or interventions, as well as more qualitative analyses of the experiences of different types of policies among the people and families that need to draw on the collective resources.
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| 2. |
- Bergqvist, Monica
(författare)
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Drug-related problems : nurses' role and responsibility
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Drug-related problems (DRPs) are common and can cause serious adverse effects, even death. The elderly are an exposed group having a higher prevalence of DRPs. As nurses are involved in all steps of the medication process they are particularly well positioned to detect, prevent and alert for DRPs. Nurses are usually situated in thefrontline when medication errors occur and are thus exposed to being responsible for such. The aims of this thesis was to evaluate if nurses can improve the quality of drug therapy, and to investigate what types of medication error most frequently reported and which factors most frequently preceded an error. Study I was designed to determine whether medication reviews made by a clinical pharmacologist and a nurse could affect rates of re-hospitalisation and/or death in hospitalized patients. DRPs detected and judged to be of clinical relevance resulted in written advice to the physician in charge of the patient. In 150 patients, 299 DRPs were found which resulted in 106 advice´s to the physicians. After 6 months readmission and death was measured and compared with patients in a control group receiving usual care, and there was no statistically significant difference in the two groups. In Study II 15 nurses conducted structured, nurse-led medication reviews after a 1-day education in clinical pharmacology. The nurses identified 59 clinically relevant DRPs in 80 patients, not detected by the usual care. Out of these, 37 DRPs resulted in an intervention such as dose reduction or withdrawal of one or more drugs. Study III was designed to determine whether medication reviews made by nurses could improve the quality of the drug therapy of elderly hospitalized patients. In 250 patient, 86 clinically significant DRPs were found not detected by the usual care. After 3 months re-admission and inappropriate drug use were measured and compared with patients in a control group receiving usual care, and there was no statistically significant difference in the two groups. In Study IV a content analysis was used to develop a tentative classification model of medication errors and contributing factors. The findings showed a high level of complexity with system and human factors interacting. In Study V 585 errors made by nurses were analyzed. Inexperienced nurses and male nurses were reported for a higher number of medication errors than their number in Sweden would lead one to expect. Lack of knowledge was a contributing factor more often associated with inexperienced nurses. Practice beyond scope of practice was more often associated with male nurses. Conclusion, DRPs are common. By using nurse-led medication review DRPs not detected by the usual care could be found. Medication errors made by nurses are a result of interrelated human and system factors. Experienced nurses can be a valuable resource for improving the quality of drug-treatment and for ensuring patient safety.
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| 3. |
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| 4. |
- Egelström, Monica
(författare)
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Samma lärare – olika praktiker? : en studie av literacy och meningsskapande i grundskolans tidiga ämnesundervisning
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on school subjects as arenas for students' literacy development and meaning making. How instructional practices are formed create different preconditions for students' opportunities of literacy development and meaning making. The following questions have been explored: 1) How is instruction in mathematics and history organized and structured as preconditions for literacy practices?, 2) What instructional practices for literacy development and meaning making can be found in the school subjects mathematics and history?, and 3) How can existing instruction be used to formulate a zone of proximal development for educational practices in relation to students' literacy development and meaning making?Four teachers and their instruction in mathematics and history in 5th grade (students typically 11 years old) were followed. Classroom observations and teacher interviews were used as methods for data collection. Teacher interviews were carried out before, during, and after observational periods. The study draws on theories of literacy as situated practices (Barton & Hamilton, 2000; Street, 1984). For the analysis activity theory (Engeström, 2015; Leontiev, 1986) was used to create understandings of the two school subjects as human activity systems. To identify literacy practices within these systems autonomous and ideological models of literacy (Street, 1984) were used together with models of important resources (Freebody & Luke, 1990) and discourses (Ivanič, 2004) of literacy.The results indicate that school subjects can be understood as different activity systems. Mathematics and history instruction were directed at different objects, in relation to content but also in how the object was perceived by the teachers as subjects. The activity system and its object had consequences for the role of the teacher subject in the system, but also for student roles. Different objects were also linked to differences in how the class was considered as community of work and how division of labor was formed in this community. Differences in the activity systems seemed to be related to differences in literacy practices. The activity systems were at least partly related to different models of literacy and which resources and discourses of literacy were presented to students. Different communities of work implied different opportunities to use joint work as a tool for meaning making. Likewise, actions seemed differently linked as chains of literacy events in the two activity systems. Important, though, in both subjects a tertiary contradiction could be identified, which indicate a zone of proximal development for both subjects in relation to students' literacy development and meaning making.
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| 5. |
- Elsir, Tamador, et al.
(författare)
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A study of embryonic stem cell-related proteins in human astrocytomas : Identification of Nanog as a predictor of survival
- 2014
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 134:5, s. 1123-1131
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies suggest that the regulatory networks controlling the functions of stem cells during development may be abnormally active in human cancers. An embryonic stem cell (ESC) gene signature was found to correlate with a more undifferentiated phenotype of several human cancer types including gliomas, and associated with poor prognosis in breast cancer. In the present study, we used tissue microarrays of 80 low-grade (WHO grade II) and 98 high-grade human gliomas (WHO grade III and IV) to investigate the presence of the ESC-related proteins Nanog, Klf4, Oct4, Sox2 and c-Myc by immunohistochemistry. While similar patterns of co-expressed proteins between low- and high-grade gliomas were present, we found up-regulated protein levels of Nanog, Klf4, Oct4 and Sox2 in high-grade gliomas. Survival analysis by Kaplan-Meier analysis revealed a significant shorter survival in the subgroups of low-grade astrocytomas (n=42) with high levels of Nanog protein (p=0.0067) and of Klf4 protein (p=0.0368), in high-grade astrocytomas (n=85) with high levels of Nanog (p=0.0042), Klf4 (p=0.0447), and c-Myc (p=0.0078) and in glioblastomas only (n=71) with high levels of Nanog (p=0.0422) and of c-Myc (p= 0.0256). In the multivariate model, Nanog was identified as an independent prognostic factor in the subgroups of low-grade astrocytomas (p=0.0039), high-grade astrocytomas (p=0.0124) and glioblastomas only (p=0.0544), together with established clinical variables in these tumors. These findings provide further evidence for the joint regulatory pathways of ESC-related proteins in gliomas and identify Nanog as one of the key players in determining clinical outcome of human astrocytomas.
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| 6. |
- Kalliokoski, Paul, et al.
(författare)
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Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency : a before-and-after treatment study
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.
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| 7. |
- Kalliokoski, Paul, 1965-, et al.
(författare)
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Physical performance and 25-hydroxyvitamin D : a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers
- 2013
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background:Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).Methods:Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.Results:Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).Conclusions:Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.
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| 8. |
- Lindblom, Sebastian, et al.
(författare)
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Lifestyle counseling in patients with hypertension in primary health care and its association with antihypertensive pharmacotherapy
- 2024
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Ingår i: The Journal of Clinical Hypertension. - 1524-6175 .- 1751-7176. ; 26:7, s. 816-824
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.
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| 9. |
- Lundberg, Olle, et al.
(författare)
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The effect of social protection and income maintenance policies on health and health inequalities
- 2013
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 23:Suppl. 1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundAs a starting point we review the existing evidence on welfare states, health and health inequalities, from 2005 onwards. Three different approaches emerge in these previous studies – the welfare regime approach, the welfare institutions approach and the social spending approach. While no clear picture emerges for the welfare regime approach, summarising findings regarding the institutional and expenditure approach suggest that a higher degree of generosity and social spending benefits public health. These are therefore approaches we follow to arrive at a better understanding of what type of policies are linked to smaller inequalities in health across the life-course.MethodsA starting point in the analyses is the relation between income, poverty and mortality. The cross-national variation in poverty rates, both absolute (poverty threshold) and relative (60 per cent of median income) measure, and mortality rates in European 26 countries will be considered.The second step in the analysis focuses on the relationship between social rights and subjective health in Europe, with a focus on national variations and changes in social rights to levels and changes in subjective health outcomes across several countries. The data holds information regarding social rights and social expenditure, including individual data from EU-SILC.ResultsPreliminary results indicate that it is the totality of social protection that is important rather than individual policies. A sub-study regarding social rights and health among youth highlight also the importance of active and passive labour market policy in the 16 included countries.ConclusionsIn sum our diverse approach to analysing welfare state efforts and their links to health inequalities suggest that there is a clear relationship between more ambitious policies and smaller inequalities in health. These results are discussed in relation to previous findings.
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| 10. |
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