| 1. |
- Anttila, Sten, et al.
(författare)
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Housing programs and case management for reducing homelessness and increasing residential stability for homeless people
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The Universal Declaration of Human Rights (Article 25) states that everyone has a right to housing. Yet according to the UNHCR there are approximately 100 million homeless people worldwide. Homelessness has many negative detrimental consequences on an individual as well as on a societal level. The condition of homeless seriously affects well-being and health in general and may contribute to mental illness in particular. Once homeless, people tend to be deprived of economic, social and psychological resources that are necessary in order to get a new accommodation. If this happens the resources of some clients may be too poor and few to prevent future evictions.Case management is a collaborative process, including assessment, planning, facilitation and advocacy for options and services, intended to make sure that the client’s needs are met. Intensive case management, including assertive community treatment, is intended to ensure that the client receives sufficient services, support and treatment when and where it is needed. In this way intensive case management (case load <1:15, 24-7 availability, and the combined competence of a multidisciplinary team), may help homeless people to obtain accommodation, and once housed avoid eviction.Housing programs are more or less based on housing philosophies. According to one philosophy stable and independent housing is needed for the client to become treatment ready. Housing should neither be contingent on sobriety nor on treatment compliance, but only on rules that apply for ordinary tenants. In other words housing is parallel to and not integrated with treatment, or with other services. An alternative philosophy is based on the assumption that some clients (possibly those with a bio-chemical dependence on drugs) may need a transitional period of sobriety and treatment compliance, before they can live independently in their own apartments. Without this transitional phase the assumption is that they will soon face eviction, and return to homelessness. According to this philosophy housing is integrated with treatment. By combining housing and case management within the framework of a comprehensive program, the work to find accommodation and to prevent eviction is assumed to be facilitated.The objective was to assess the effectiveness of 9 possible combinations of housing programs and case management as means to increase residential stability and reduce homelessness. The possible combinations were based on three housing alternatives and three case management alternatives which entails 36 possible comparisons:Housing parallel to treatment, housing integrated with treatment, and no housingIntensive of case management (ICM and ACT), ordinary case management, and no case management.Electronic databases were searched by means of terms referring to population, intervention, and design (Campbell Library, Cochrane Library (including CENTRAL), PubMed, PsycINFO, Sociological Abstracts, Social Services Abstracts, ASSIA, CINAHL, ERIC, and Dissertation Abstracts International). Reference lists were hand searched, and international experts were contacted. For a study to be included the following criteria had to be met:Population: homeless or at risk of becoming homelessIntervention: housing programs with case management, housing programs without case management, or case management without a housing programComparison: any of the alternative interventions above, plus usual care, waiting lists, or no interventionOutcome: residential stability or homelessnessDesign: randomized controlled trials or observational studies (with comparison groups matched at baseline or on propensity scores)Pairs of reviewers independently screened abstracts, and read full text documents. Data was extracted and coded by two reviewers. Two reviewers also assessed risks of bias for each study and their outcomes. In several cases data had to be recalculated in order to fit the format necessary for meta-analysis based on Review Manager.After screening 1, 764 abstracts and assessing 276 documents in full text, 32 unique studies were included (26 randomized controlled trials and 6 observational studies) in this review. All studies were from the USA except three, which were undertaken in the UK (two randomized controlled trials and one observational study). The number of included studies is thus relatively high, but the body of evidence is poor, as most studies are characterized by high risk of aggregated bias (11 studies) or moderate risk of aggregated bias (15 studies and 19 comparisons). Only 6 studies were classified as having low aggregated risk of bias. In addition, most studies are rather old. The median publication year is 1998. There are 16 studies published between 2000 and 2010 (11 randomized trials and five observational studies). Since 2005 only five included studies were published (three randomized trials and two observational studies). The results can be summarized in seven points:a) Housing parallel to treatment is not superior to housing integrated with treatment or vice versa.b) Empirical results indicate that parallel housing as such is superior to no housing.c) There is not sufficient evidence to conclude that integrated housing as such is superior to no housing.d) Empirical results indicate that intensive case management as such (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.).e) Empirical results indicate that parallel housing in combination with intensive case management (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.).f)There is not sufficient evidence to conclude that integrated housing in combination with intensive case management (ACT and ICM) is superior to usual care (such as drop in centers, outpatient treatment, ordinary after care, etc.) Conclusion: Parallel housing, in combination with intensive case management (ICM and ACT), improves housing outcomes in comparison to usual care (outpatient treatment, drop in centers, ordinary after care, brokered case management, etc.). Intensive case management as well as housing contributes to this effect. However, evidence is not decisive when parallel housing is compared to integrated housing. Empirical results are highly contradictory. Studies focusing on specific subgroups such as women and persons with severe substance abuse problems are required.
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| 2. |
- Brännström, Inger, 1945-, et al.
(författare)
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Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme
- 1993
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 22:6, s. 1026-1037
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Tidskriftsartikel (refereegranskat)abstract
- Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjö, in Northern Sweden. The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-stratified random sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population. These multiple cross-sectional surveys comprised a self-administered questionnaire and a health examination. Of the study population 95% (n = 1499) and 80% of those in the reference area (n = 3208) participated. Subjects were classified with regard to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures. When simultaneously adjusting for several potential confounders we used a logistic regression analysis. Initially, more than half of the study population, both males and females, had and elevated (> or = 6.5 mmol/l) serum cholesterol level. After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically significant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when perceived good health was measured, especially in variables indicating emotional and social support. When sex, age and social factors had been accounted for there was not clear change over the years in perceived good health.
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| 3. |
- Brännström, Kristoffer, et al.
(författare)
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A Generic Method for Design of Oligomer-Specific Antibodies
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:3, s. e90857-
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Tidskriftsartikel (refereegranskat)abstract
- Antibodies that preferentially and specifically target pathological oligomeric protein and peptide assemblies, as opposed to their monomeric and amyloid counterparts, provide therapeutic and diagnostic opportunities for protein misfolding diseases. Unfortunately, the molecular properties associated with oligomer-specific antibodies are not well understood, and this limits targeted design and development. We present here a generic method that enables the design and optimisation of oligomer-specific antibodies. The method takes a two-step approach where discrimination between oligomers and fibrils is first accomplished through identification of cryptic epitopes exclusively buried within the structure of the fibrillar form. The second step discriminates between monomers and oligomers based on differences in avidity. We show here that a simple divalent mode of interaction, as within e. g. the IgG isotype, can increase the binding strength of the antibody up to 1500 times compared to its monovalent counterpart. We expose how the ability to bind oligomers is affected by the monovalent affinity and the turnover rate of the binding and, importantly, also how oligomer specificity is only valid within a specific concentration range. We provide an example of the method by creating and characterising a spectrum of different monoclonal antibodies against both the A beta peptide and alpha-synuclein that are associated with Alzheimer's and Parkinson's diseases, respectively. The approach is however generic, does not require identification of oligomer-specific architectures, and is, in essence, applicable to all polypeptides that form oligomeric and fibrillar assemblies.
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| 4. |
- Brännström, Lars, 1972-, et al.
(författare)
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Intergenerational transmission of placement in out-of-home care : Mediation and interaction by educational attainment
- 2022
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Ingår i: International Journal of Child Abuse & Neglect. - : Elsevier BV. - 0145-2134 .- 1873-7757. ; 123
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with childhood experiences of out-of-home care (OHC) have elevated risks of having their own children taken into societal care. High educational attainment has been linked to favorable long-term outcomes in a host of previous studies on OHC alumni. This could be indicative of resilience, which may also have protective potential against intergenerational continuity of OHC placements.Objective: The present study examined the processes of mediation and interaction by educational attainment, here conceptualized as having completed upper secondary school, regarding the intergenerational transmission of placement in OHC.Participants and setting: Longitudinal data came from a Swedish cohort of parents (and their children) born in 1953 (n = 11,338).Methods: Associations between parental experience of OHC and their children's placement in OHC were analyzed by means of binary logistic regression. Four-way decomposition was used to explore mediation and interaction by parental educational attainment.Results: The odds of having at least one child being placed in OHC was more than six-fold (OR = 6.67, 95% CI = 5.28; 8.06) in the OHC group compared to majority population peers. Mediation and/or interaction by educational attainment accounted for a substantial proportion of the overall association (53%). Interaction effects appeared to be more important for the outcome than mediation.Conclusions: Having completed upper secondary school seems to reflect processes of resilience with the potential to break the intergenerational transmission of placement in OHC. These findings suggest that the impact of enhanced educational attainment of OHC populations may have potential of extending into the fate of the next generation.
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| 5. |
- S. Straatmann, Viviane, et al.
(författare)
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Associations between out-of-home care and mental health disorders within and across generations in a Swedish birth cohort
- 2022
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Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown that mental health disorders (MHD) among parents might be an important mechanism in the intergenerational transmission of out-of-home care (OHC). The current study aimed to further study this interplay by investigating the associations between OHC and MHD within and across generations. We used prospective data from the Stockholm Birth Cohort Multigenerational Study (SBC Multigen) on 9033 cohort members (Generation 1; G1) and their 15,305 sons and daughters (Generation 2; G2). By odds ratios of generalised structural equation modelling, we investigated the intergenerational transmission of OHC and MHD, respectively, as well as the association between OHC and MHD within each generation. Second, we examined the associations between OHC and MHD across the two generations. In order to explore possible sex differences, we performed the analyses stratified by the sex of G2. The results showed an intergenerational transmission of OHC, irrespective of sex. Regarding the intergenerational transmission of MHD, it was shown for both sexes although only statistically significant among G2 males. OHC was associated with MHD within both generations; in G2, this association was stronger among the males. While we found no direct association between OHC in G1 and MHD in G2, there was a significant association between MHD in G1 and OHC in G2. The latter was more evident among G2 females than G2 males. We conclude that OHC and MHD seem to be processes intertwined both within and across generations, with some variation according to sex. Although there did not seem to be any direct influences of OHC in one generation on MHD in the next generation, there was some indication of indirect paths going via parental MHD and child OHC.
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| 6. |
- Sivertsson, Fredrik, 1984-, et al.
(författare)
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Offending trajectories from childhood to retirement age : Findings from the Stockholm birth cohort study
- 2024
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Ingår i: Journal of criminal justice. - 0047-2352 .- 1873-6203. ; 91
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The current study explores heterogeneity in the aggregate age-crime curve. This is achieved by analyzing to what extent there is empirical support for the existence of pivotal typologies in developmental and life-course criminology, as well as whether there is any heterogeneity in trajectories among adult-onset offenders (first recorded for crime at age 25 or later).Methods: Data were drawn from a population-representative birth cohort of 14,608 males and females, followed prospectively in registers from age nine to 64. Trajectories of antisocial and criminal behavior were identified by means of group-based trajectory modelling.Results: A small group with a high prevalence of crime across the life course, among both males and females, was found. Furthermore, a large proportion of offenders were adult-onset offenders, and there was meaningful heterogeneity in their criminal trajectories. However, the data did not lend much support to the hypothesized phenomenon of late-blooming.Conclusion: There is meaningful heterogeneity in the aggregate age-crime curve, including trajectories that resonate fairly well with predictions derived from Moffitt's taxonomy. Nevertheless, there are firm reasons for theorizing proximate causes for the onset and continuation of crime beyond emerging adulthood.
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| 7. |
- Aden, A S, et al.
(författare)
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The growth chart - a road to health chart? : Maternal comprehension of the growth chart in two Somali villages
- 1990
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Ingår i: Paediatric and Perinatal Epidemiology. - : Wiley. - 0269-5022 .- 1365-3016. ; 4:3, s. 340-350
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Tidskriftsartikel (refereegranskat)abstract
- Growth monitoring is so far not implemented on a large scale in the Somali health services. Available reports indicate that growth faltering is common. However, the use of growth charts as a tool for health education has been questioned. This study examines the ability of 199, predominantly illiterate, rural Somali mothers to understand the growth chart message after an intensive period of growth chart use and education. During a home-based interview the mothers were asked to combine a set of four growth curves with a set of four pictures, showing the corresponding developments of four children. The mothers managed significantly better to interpret the charts than could be expected by chance alone. Maternal age, number of children and literacy did not differ much between those who correctly and incorrectly combined pictures and charts. Almost all mothers recognised the value of the growth chart as being good for the control and promotion of their children's health and/or growth. We conclude that the growth chart may be an applicable and appropriate tool even with illiterate mothers, provided that other prerequisites for successful growth monitoring, e.g. appropriate health services, are available.
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| 8. |
- Alm, Susanne, et al.
(författare)
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Framtidstro - spelar det roll var man bor?
- 2011
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Ingår i: Utanförskap. - Stockholm : Dialogos Förlag. - 9789175042428 ; , s. 211-242
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
- Almquist, Ylva B., et al.
(författare)
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A decade lost : does educational success mitigate the increased risks of premature death among children with experience of out-of-home care?
- 2018
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 72:11, s. 997-1002
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Tidskriftsartikel (refereegranskat)abstract
- Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.
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