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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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Agardh, Carl-David, et al.
(författare)
Diabetic control in community care. The use of clinical evaluation and hemoglobin A1
1985
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 3:1, s. 15-18
Tidskriftsartikel (refereegranskat) abstract
Diabetic control was evaluated in 50 consecutive patients attending a community care centre, either by clinical criteria or by determination of glycosylated hemoglobin (HbA1). Two methods used for the determination of HbA1 were found to give similar results, namely ion exchange chromatography and agar gel electrophoresis. On a group basis, good correlation was observed between HbA1 samples analysed prior to and following the elimination of the labile HbA1 fraction. When comparing three treatment modes (diet alone, hypoglycemic agents or insulin), no significant differences in HbA1 levels were noted. Patients considered to have satisfactory and poor control had significantly higher HbA1 levels than those considered to have good control, while no differences were seen between those considered to have satisfactory or poor control. It is concluded that the methods described for the determination of HbA1 yield similar results. Clinical evaluation of diabetic control is reliable in patients classified to have good or poor control. However, in many patients who are considered to have satisfactory control, regular determinations of HbA1 provide valuable additional information.
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Arnbjörnsson, Einar, et al.
(författare)
Changes in hospital costs for an appendectomy : 1955, 1965, and 1975
1983
Ingår i: The American Journal of Surgery. - : Elsevier BV. - 0002-9610. ; 146:3, s. 342-345
Tidskriftsartikel (refereegranskat) abstract
A reduction in the number of postoperative bed days for patients who underwent appendectomy led to a study of changes in hospital costs of appendectomies for the years 1955, and 1965, and 1975. No significant changes were found in the total hospital costs. However, the postoperative costs decreased by 36 percent from 1955 to 1975 due to a decrease in the mean duration of hospital stay. During the same period of time, the perioperative costs increased by 90 percent due to increased length of operation time correlated with an increasing proportion of inexperienced operating surgeons. At present, there seem to be few possible ways to increase the cost efficiency of treating appendicitis.
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Calltorp, J, et al.
(författare)
Technology assessment activities in Sweden
1989
Ingår i: International Journal of Technology Assessment in Health Care. - 0266-4623 .- 1471-6348. ; 5:2, s. 263-68
Tidskriftsartikel (refereegranskat)
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Isacson, D, et al.
(författare)
Patterns of psychotropic drug use in a Swedish community
1988
Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 6:1, s. 51-58
Tidskriftsartikel (refereegranskat) abstract
In this study individual data on prescription drug purchases in the total population of a Swedish municipality have been analyzed in order to study changes in the use of psychotropic drugs (in this study mainly hypnotics, sedatives and minor tranquillizers) over time. The number of psychotropic prescriptions decreased by 27% during the twelve-year period 1972-1983. The proportion of psychotropic drug users in the total population decreased from 16 to 11%. This decrease in psychotropic drug use was not evenly distributed within the population. The proportion of users decreased from 10 to 4% in the age group 15-44 years and from 23 to 15% in the age group 45-64 years, while the higher proportion of users in the oldest age group, 65 years and older, only decreased from 33 to 28%. Psychotropic drug use was almost twice as common among females as compared to males throughout the study period. Psychotropic drug use among heavy users of prescription drugs in general--identified with the use of a sex- and age-specific definition--was also studied. The decrease in psychotropic drug use during the time period studied was much greater among non-heavy users as compared to heavy users.
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Isacson, D, et al.
(författare)
Psychotropic drug use in a Swedish community : Patterns of individual use during 2 years
1988
Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 27:3, s. 263-67
Tidskriftsartikel (refereegranskat) abstract
Psychotropic drug use in a Swedish community with a general population of about 20,000 was studied using data from a research registry on prescriptions. Patterns of individual psychotropic drug use during 2 years, 1980 and 1981, were analyzed. Use during the second year was studied in relation to use during the first year, and individuals with continued and new use were identified. About two thirds of those who obtained psychotropics during the first year continued using such drugs during the following year. Among those with no use during the first year, 6% obtained psychotropic drugs during the second year. Both continued and new use increased with age. Psychotropic drug use was nearly twice as common among women as compared to men among new users, whereas practically no sex difference was observed in continued use among previous users of psychotropics. Despite the finding that male psychotropic drug users were almost as likely as females to continue using these drugs, the overall proportion of continuous users in the population remained considerably higher among women as compared to men. The results from this study suggest that the greater use of psychotropics among women can be explained by a greater extent of occasional use as well as continuous use among women as compared to men.
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Jonsson, Egon
(författare)
Studies in health economics
1980
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
During the last few decades, the Swedish public health sector has been greatly expanded. At present, about ten per cent of the gross national product goes to health care. Claims for more resources for health care are in prospect. However, demands are increasing from other sectors as well, and it is doubtful whether the share allocated to the health care sector will be allowed to increase at the same rapid pace as before. In this context it is crucial that policy options for health care be identified and evaluated not only in terms of their risks and benefits but also in terms of their accompanying resource requirements. This will require increased knowledge of the magnitude and measurement of health services resources and their relation to the benefits derived from efforts to prevent, cure and alleviate disease and disability. Concepts fundamental to the practice of health care are benefits of the patient and the associated risk of achieving these. Fundamental to economics is the ever-existing consideration of scarce resources, their efficient use and just allocation. These latter dimensions are considered in the studies presented in this dissertation: a comparison of a Swedish and a U.S. community hospital, an analysis of volume and distribution of coronary care units and an economic assessment of computerized tomography.
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Kebbon, L, et al.
(författare)
Psychiatric symptoms and psychosocial problems in primary health care as seen by doctors
1985
Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 3:1, s. 23-30
Tidskriftsartikel (refereegranskat) abstract
All visits at a primary health care centre in Sweden were studied during four weeks. The frequency of psychiatric symptoms or psychosocial problems noted by the doctors was recorded on a special form in addition to routine registration of diagnoses. Such problems were noted in 553 out of 3 205 visits, corresponding to 17.3%. Considerable variation in registering problems was found between individual physicians and between different categories of doctors. The most common problems were nervousness, anxiety, psychosomatic disorders, and depression. Mental problems were especially common in connection with gastritis, precordial pain, and abdominal pain. There was a difference between the sexes: 20% of the female patients had mental problems registered compared with 14% of the male patients. Psychiatric diagnoses, however, were registered in only 6% of all cases. Of the 553 patients with mental problems, 16% were considered in need of a specialist, 52% could be dealt with at the health centre, and for 32% no special treatment for the mental problems was regarded necessary. One conclusion is that the routine registration of diagnoses at the health centre covers only some of the mental problems and is therefore insufficient in terms of planning psychiatric resources and the training of doctors. Possible reasons for the differences found are discussed.
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Klareskog, L, et al.
(författare)
Förtidspensionerade i Tierp
1980
Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 3, s. 162-69
Tidskriftsartikel (refereegranskat)
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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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Rasmussen, F, et al.
(författare)
Life table methods applied to use of medical care and of prescription drugs in early childhood
1989
Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738. ; 43:2, s. 140-46
Tidskriftsartikel (refereegranskat) abstract
Life table methods were applied to analyses of longitudinal data on the use of medical care during the first 5 years of life among all 1701 children born in a Swedish semirural municipality. Cumulative proportions of the children who had used particular types of medical care or prescription drugs at least once by certain ages were estimated. By the fifth birthday, 98% had made at least one visit to any physician and 82% at least one visit to a paediatrician. By the fifth birthday at least one prescription for antibiotics had been purchased at a pharmacy by 82%; and 33% had been admitted to inpatient hospital care at least once (excluding immediate postnatal care). Acute conditions and more chronic diseases were also studied using these methods. At least one visit to a physician at a primary health care centre had been made for acute otitis media in 65% of 5 year olds and for atopic dermatitis in 8%.
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Rasmussen, F, et al.
(författare)
Physician visits and prescribed drugs among young children and their mothers
1987
Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 5:4, s. 225-31
Tidskriftsartikel (refereegranskat) abstract
The extent to which use of medical services by young children could be predicted by mothers' use of medical services and by certain family characteristics has been studied. The study population comprised 591 children two to four years of age in a Swedish rural municipality. Register data on physician visits and prescription drug purchases during 1979 constituted main sources of information. Statistically significant positive associations were found between number of physician visits made by the children and by their mothers and between number of prescription drug purchases made for the children and for the mothers. More physician visits and prescription drug purchases were made for the children of younger mothers than for those of older mothers. Six to eight per cent of the variation in the use of medical services by the young children was explained in multiple regression models including mainly mothers' use of medical care, mothers' age and children's age.
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