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Follér, Maj-Lis, 1946
(författare)
A new approach to community health
1989
Ingår i: Social Science and Medicine. - 0277-9536. ; 28:8, s. 811-818
Tidskriftsartikel (refereegranskat) abstract
This article deals with the local health care among the Shipibo-Conibo in eastern Peru. A project called AMETRA—application of traditional medicine—is functioning in the area. The aim of AMETRA is to give courses and stimulate co-operation between traditional medical practice and Western medicine. The solutions to the health problems are seen in direct relation to the socio-economic structure and to the environmental prerequisites. The aim and purposes of AMETRA are described and analysed. It is proposed that the two medical systems should co-operate in such a manner that their complementary nature is emphasized and fully utilized.
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Westerberg, Ingvar, 1942-
(författare)
Produktion, produktivitet och kostnader i svensk tandvård
1987
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
The thesis contains projects at a national as well as a clinical level.On a national level a study is made of productivity in adult dental care in both its private and its public·sectors. By using the calculated productivity for the years 1975-1984 a variety of factors are tested for the ability to explain firstly the development of productivity in private dental care and in public dental care respectively, and secondly the differences in productivity between the two sectors.The productivity measures used are the number of patients treated per dentist hour and the dentist fee per dentist hour. The results show in the case of the first mentioned productivity measure a somewhat higher value for public dental care for all of the years studied. For the productivity measures, dentist's fee per dentist hour, private dental care shows a 20-30 percent higher productivity.Differences in the age structure of the patients and different treatment panoramas can explain a great many of the differences in productivity. However the question is why the treatment panoramas of the two sectors are so different, a difference that can scarcely be explained by differences in the patient population. There are grounds, therefore, for believing that the differences can be explained on the basis of differences in the activity goals of the two sectors.As a complement to the productivity studies outlined above the costs of treating a patient have also been compared. The results show considerably higher costs in public dental care, though the difference has been greatly reduced during the 80s due largely to a lower rate of increase in the overheads of dentists in the public sector over the last few years.The second study comprises a production economic study of 144 public dental care clinics in five counties in southern Sweden. The variation in productivity is tested on the basis of various explanatory factors using multiple regression analysis according to OLS. The regression models used were a linear function, an exponential function of the Cobb-Douglas type as well as a transcendental function of the type first formulated by Reinhardt in 1972. The results show that the high productivity clinic is smaller (1-2 dentists), has a larger staff of assistants, has fewer children and adolescents among its patients and shows higher productivity also in the case of the other productivity measure.The study also contains an estimation of the production function for the 144 clinics. A Cobb-Douglas production function is used as a regression mode. The results point to significant estimated coefficient values for all production factors. The coefficient values are, as could be expected, positive and between zero and one in size. The results are in agreement with most of the estimations obtained from previous studies.
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Westman, Göran, 1946-
(författare)
Planning primary health care provision : assessment of development work at a health centre
1986
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes.The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected.Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered.Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration.Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others.
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Qvarsell, Roger, 1950-
(författare)
Ordning och behandling : psykiatri och sinnessjukvård i Sverige under 1800-talets första hälft
1982
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
During the first half of the 19th century institutions for the treatment of the insane were established throughout Europe and North America. These institutions were generally the result of government initiative and were founded on a belief that existed in the new psychiatric theories of treatment.Psychiatry was, at this time, an embryonic science, in which great conflict existed between different theoretical schools of thought, but in which a remarkable concensus existed regarding methods of treatment. Treatment was based on a view of the nature of man inspired by the philosophy of the Enlightenment, in which up-bringing was considered to be able to affect a person's entire character.In 1823, the Swedish Riksdag voted in favour of the etablishment of treatment hospitals. The background to this decision was the belief that it should be possible to diminish the costs of caring for the poor if mental illness could be treated. However, fears of a general increase in social unrest and philanthropic motives seem also to have been important factors. Sweden's first hospital for the treatment of the insane was established in Vadstena in 1826. Georg Engström (1 795-1 855) became the country's first full-time asylum doctor.Georg Engström was well-read in German, French and English psychiatric literature, but never himself formulated any psychiatric theory, neither did he write any articles of a principiai nature. His psychiatric activities may, however, be followed in his comprehensive medical journals and regular official reports. Engström saw the roots of mental illness in the existence of a surplus, a shortage, or an inbalance in the energy of the psyche. The cause of illness lay in the patients manner of living and, Engström stressed, in the importance of intense feelings and passions. The essence of treatment lay in the patient's being kept occupied and in his manner of living. Most of the recommendations for methods of treatment contained in the literature were tried out, a number of which — for example, being spun in a revolving chair — were quickly abandoned.The development of psychiatry and of the care and treatment of the mentally ill during the first half of the 19th century can be seen as a sign of the fact that science itself was developing and becoming paradigmatic. However, it is also possible the view developments from the perspective of the ideology of treatment and to focus on the way in which the philosophy of treatment and its concomitent optimism spread and reformed the old asylum system. Finally, it is also possible to observe developments from a pedagogical perspective, stressing the state's desire for control and order in a situation in which there were fears of an increasing social unrest.
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