| 1. |
- Björkenstam, Emma, et al.
(författare)
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Quality of medical care and excess mortality in psychiatric patients : a nationwide register-based study in Sweden
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:1, s. e000778-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients.DESIGN: A register-based cohort study.SETTING: All individuals aged 20-79 years in Sweden in 2005.PARTICIPANTS: In total 6 294 339 individuals.PRIMARY OUTCOME MEASURE: The individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients.RESULTS: Compared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care.CONCLUSION: This study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.
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| 2. |
- Burström, Bo, et al.
(författare)
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Policy measures and the survival of foster infants in Stockholm 1878-1925
- 2012
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 22:1, s. 56-60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: At the end of the 19th century, infant mortality was high in urban and rural areas in Sweden. In Stockholm, the mortality rate was particularly high among foster children. This study addresses the importance for health of targeted public policies and their local implementation in the reduction of excess mortality among foster children in Stockholm at the turn of the 19th century. In response to public concern, a law was passed in 1902 on inspections of foster homes. Stockholm city employed a handful of inspectors who visited foster homes and advised parents on child care and feeding. METHODS: Analysis of historical records from the City of Stockholm was combined with epidemiological analysis of mortality rates and hazard ratios on individual-level data for 112 746 children aged <1 year residing in one part of Stockholm between 1878 and 1925. Hazard ratios of mortality were calculated using Cox' regression analysis. RESULTS: Mortality rates of foster infants exceeded 300/1000 before 1903. Ten years later the mortality rates among foster children had declined and were similar to other children born in and out of wedlock. Historical accounts and epidemiological analysis of individual-level data over a longer time period showed similar results. CONCLUSIONS: Targeted policy measures to foster children may have potentiated the positive health effects of other universal policies, such as improved living conditions, clean water and sanitation for the whole population in the city, contributing to an equalization of mortality rates between different groups.
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| 3. |
- Fritzell, Sara, et al.
(författare)
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Does non-employment contribute to the health disadvantage among lone mothers in Britain, Italy and Sweden? Family policy and synergy effects
- 2012
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Ingår i: Health and Place. - : Elsevier BV. - 1353-8292 .- 1873-2054. ; 18:2, s. 199-208
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Tidskriftsartikel (refereegranskat)abstract
- This study analyses self-rated health and non-employment and potential synergy effects among lone and couple mothers aged 25–59 in Britain, Sweden and Italy, representing different family policy categories using data from national surveys (2000–2005). Synergy effects on health were calculated by synergy index. Non-employment only marginally contributed to the excess risk of poor health among lone mothers but there were synergy effects between lone motherhood and non-employment in all three countries, producing a higher risk of poor health than would be expected from a simple addition of these exposures. Results are discussed in relation to the different family policy and living contexts.
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| 4. |
- Marttila, Anneli, et al.
(författare)
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Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers
- 2012
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Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundLong-term recipients of social assistance face barriers to social and economic inclusion, and have poorer health and more limited opportunities for improving their health than many other groups in the population. During recent decades there have been changes in Swedish social policy, with cutbacks in public benefits and a re-emphasis on means-tested policies. In this context, it is important to investigate the necessary conditions for social workers to offer social assistance and services, as well as the mediating role of social workers between public policies and their clients. Swedish social services aim to promote social inclusion by strengthening the individual´s own resources. We investigated the issues that arise when providing social services to long-term social assistance clients within the framework of resilience, which focuses on the processes leading to positive functioning in adverse conditions.MethodsInterviews were conducted with 23 social workers in Stockholm and analysed by qualitative content analysis.ResultsThe main theme to emerge from the interviews concerned the constraints that the social workers faced in providing social services to social assistance clients. The first subtheme focused on dilemmas in the interaction between social workers and clients resulting from the dual role of exercising authority and supporting and building trust with clients. Working conditions of social workers also played a crucial role. The second subtheme addressed the impact of the societal context, such as labour market opportunities and coordination between authorities.ConclusionsOverall, we found that social workers to a great extent tried to find individual solutions to structural problems. To provide resilience-enhancing social services to long-term social assistance clients with varying obstacles and needs requires a constructive working environment, supportive societal structures and inter-sectoral cooperation between different authorities.
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| 5. |
- Marttila, Anneli, et al.
(författare)
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Living on social assistance with chronic illness: Buffering and undermining features to well-being
- 2010
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Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 20, s. 279-279
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.MethodsSeventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.ResultsThe study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.ConclusionFrom this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.
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