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  • 1. Al-Janabi, Hareth
    et al.
    Coast, Joanna
    Flynn, Terry N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up.2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 1, p. 111-21Article in journal (Refereed)
    Abstract [en]

    Government policies to shift care into the community and demographic changes mean that unpaid (informal) carers will increasingly be relied on to deliver care, particularly to older people. As a result, careful consideration needs to be given to informal care in economic evaluations. Current methods for economic evaluations may neglect important aspects of informal care. This paper reports the development of a simple measure of the caring experience for use in economic evaluations. A meta-ethnography was used to reduce qualitative research to six conceptual attributes of caring. Sixteen semi-structured interviews were then conducted with carers of older people, to check the attributes and develop them into the measure. Six attributes of the caring experience comprise the final measure: getting on, organisational assistance, social support, activities, control, and fulfilment. The final measure (the Carer Experience Scale) focuses on the process of providing care, rather than health outcomes from caring. Arguably this provides a more direct assessment of carers' welfare. Following work to test and scale the measure, it may offer a promising way of incorporating the impact on carers in economic evaluations.

  • 2. Andersen, Ronald
    et al.
    Smedby, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Vågerö, Denny
    Cost containment, solidarity and cautious experimentation: Swedish dilemmas2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 52, no 8, p. 1195-1204Article in journal (Refereed)
    Abstract [en]

     This paper uses secondary data analysis and a literature review to explore a "Swedish Dilemma": Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay - a policy emphasizing "solidarity" - or must it decide to impose increasing constraints on health services spending and service delivery - a policy emphasizing "cost containment?" It examines recent: policies and longer term trends including: changes in health personnel and facilities, integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment - not primarily through "market mechanisms" but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.

     

     

  • 3.
    Bean, Christopher G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Winefield, Helen
    School of Psychology, University of Adelaide, Australia.
    Sargent, Charli
    Appleton Institute for Behavioural Science, Central Queensland University, Australia.
    Hutchinson, Amanda
    School of Psychology, Social Work and Social Policy, University of South Australia, Australia.
    Differential associations of job control components with both waist circumference and body mass index2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:The Job Demand-Control-Support (JDCS) model is commonly used to investigate associations between psychosocial work factors and employee health, yet research considering obesity using the JDCS model remains inconclusive.

    OBJECTIVE:This study investigates which parts of the JDCS model are associated with measures of obesity and provides a comparison between waist circumference (higher values imply central obesity) and body mass index (BMI, higher values imply overall obesity).

    METHODS:Contrary to common practice, in this study the JDCS components are not reduced into composite or global scores. In light of emerging evidence that the two components of job control (skill discretion and decision authority) could have differential associations with related health outcomes, components of the JDCS model were analysed at the subscale level. A cross-sectional design with a South Australian cohort (N = 450) combined computer-assisted telephone interview data and clinic-measured height, weight and waist circumference.

    RESULTS:After controlling for sex, age, household income, work hours and job nature (blue vs. white-collar), the two components of job control were the only parts of the JDCS model to hold significant associations with measures of obesity. Notably, the associations between skill discretion and waist circumference (b = -.502, p = .001), and skill discretion and BMI (b = -.163, p = .005) were negative. Conversely, the association between decision authority and waist circumference (b = .282, p = .022) was positive.

    CONCLUSION:These findings are significant since skill discretion and decision authority are typically combined into a composite measure of job control or decision latitude. Our findings suggest skill discretion and decision authority should be treated separately since combining these theoretically distinct components may conceal their differential associations with measures of obesity, masking their individual importance. Psychosocial work factors displayed stronger associations and explained greater variance in waist circumference compared with BMI, and possible reasons for this are discussed.

  • 4.
    Binder, Pauline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Malmö University.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 11, p. 2028-2036Article in journal (Refereed)
    Abstract [en]

    Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a ‘maternal migration effect’ as pre-migration influences on pregnant women’s post-migration care-seeking and consistent utilisation of available care. We apply the ‘three delays’ framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005–2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of ‘broken trust, which can be mutually held between women and providers. An additional factor is women’s ‘negative responses to future care’, which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 ‘language discordance’ can lead to a ‘reliance on interpreter service’, which can cause delays in Phase 3, when ‘reciprocal incongruent language ability’ is worsened by suboptimal interpreter systems. ‘Non-reciprocating care conceptualisations’, ‘limited system-level care guidelines’, and ‘low staff levels’ can additionally delay timely care in Phase 3.

  • 5.
    Blomgren, Maria
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Sundén, Eva
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Constructing a European healthcare market: the private healthcare company Capio and the strategic aspect of the drive for transparency2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 10, p. 1512-1520Article in journal (Refereed)
    Abstract [en]

    This article analyses the private healthcare company Capio and its participation in the drive for transparency in the European healthcare field. An important point of departure for the paper is that technologies for transparency, such as accounting and auditing, are not neutral devices for increased openness, but carry with them programmatic dimensions that affect our norms and rules of how healthcare is to be organized and controlled. The drive for transparency engages different actors with various motives. To investigate this we carried out semi-structured interviews with 11 persons, mainly management members of Capio. We show that transparency in healthcare has been put forward by a private actor for strategic reasons. We argue that Capio's involvement in the drive for transparency should be seen as a ‘second-order strategy’ with the aim to create advantageous opportunities in a future European healthcare market. We show that Capio, through its propagation of various transparency technologies, has put forward programmatic ideals of industrialisation, marketisation and Europeanisation in healthcare. The main conclusion is that although Capio has engaged in the drive for transparency for business reasons, the company has also furthered certain political ideals in the field. This study contributes to the literature which problematizes the division between private and public, and between business and politics in healthcare, and is of interest to a broad health policy audience.

  • 6.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Ethnicity and health: The costs and benefits of conceptualising racism and ethnicity2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347Article in journal (Refereed)
    Abstract [en]

    Papers that conceptualize ethnicity as an aspect of public health have increased in number over recent years in Social Science & Medicine, as elsewhere. This virtual special issue includes a selection of papers, mostly published in the last five years, to highlight recent developments in this area. The question of whether the risks associated with reifying ethnic categories in particular settings, thereby reinforcing racialised models of thinking, is addressed. The wisdom of seeking to construct ethnicity-type variables for the purpose of global cross-cultural comparison is queried.An unavoidable contradiction of studying ethnicity is the inevitable re-inscription of ethnic and racialised categories. Inequities in health outcome or quality of health service provision and uptake are injustices that have to be measured in order to be addressed. Whether research is qualitative or quantitative and whether or not an investigation finds inequalities, the definition of an ethnic group whether in terms of boundary or content, re-inscribes its existence as a cultural category. Furthermore, the familiar complexities of working with socio-demographic variables that relate to the individual and the population level, applies in the case of studying ethnicity and health.Ethnic groups exist because we behave as if they do: the social construction of ethnicity occurs as part of the definition of, and the search for, quantitatively and qualitatively significant differences between those groups. In appraising ethnicity, concomitant terms with over-lapping meanings are implied and, in the hope of avoiding terminological obfuscation, are briefly rehearsed below.

  • 7.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Ethnicity and health: The costs and benefits of conceptualising racism and ethnicity2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347Article in journal (Other academic)
  • 8.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    ‘What do we mean by ‘racism’?: Conceptualising the range of what we call racism in health care settings: a commentary on Peek et al.2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 71, p. 10-12Article in journal (Refereed)
  • 9. Catalano, Ralph
    et al.
    Karasek, Deborah
    Gemmill, Alison
    Falconi, April
    Goodman, Julia
    Magganas, Aristotle
    Hartig, Terry
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Institute for Housing and Urban Research.
    Very low birthweight: Dysregulated gestation versus evolutionary adaptation2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 108, p. 237-242Article in journal (Refereed)
    Abstract [en]

    Much medical literature attributes persistently high rates of very low birthweight (VLBW) to "dysregulated" gestation. We offer the alternative view that natural selection conserved well-regulated, though nonconscious, decisional biology that protects the reproductive fitness of women by spontaneously aborting gestations that would otherwise yield frail infants, particularly small males. Modern obstetric practice, however, converts some fraction of these erstwhile spontaneous abortions into live births of very small infants. We further propose that the nonconscious decisional biology of gestation exhibits preferences also seen in consciously made decisions. We hypothesize that the incidence of VLBW among male infants should vary with the population's self-reported intentions to assume financial risk. We apply time-series modeling to monthly birth counts by sex and weight from the Swedish Medical Birth Registry between January 1993 and December 2010. We gauge risk aversion with monthly data from the Micro Index of the Swedish Consumer Tendency Survey (MISCT). Consistent with our argument that nonconscious decisional biology shares risk aversion with conscious decisions, we find that the incidence of VLBW among male infants in Sweden varies with the population's self-reported intentions to assume financial risk. We find increases above expected odds of a very low weight infant among males born 1 month after increases above expected levels of self-reported risk aversion in the Swedish population. We offer this finding as support for the argument that persistently high rates of VLBW arise, at least in part, from a combination of medical interventions and mechanisms conserved by natural selection to protect reproductive fitness. (C) 2014 Elsevier Ltd. All rights reserved.

  • 10. Coast, Joanna
    et al.
    Flynn, Terry N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Natarajan, Lucy
    Sproston, Kerry
    Lewis, Jane
    Louviere, Jordan J
    Peters, Tim J
    Valuing the ICECAP capability index for older people.2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 5, p. 874-82Article in journal (Refereed)
    Abstract [en]

    This paper reports the first application of the capabilities approach to the development and valuation of an instrument for use in the economic evaluation of health and social care interventions. The ICECAP index of capability for older people focuses on quality of life rather than health or other influences on quality of life, and is intended to be used in decision making across health and social care in the UK. The measure draws on previous qualitative work in which five conceptual attributes were developed: attachment, security, role, enjoyment and control. This paper details the innovative use within health economics of further iterative qualitative work in the UK among 19 informants to refine lay terminology for each of the attributes and levels of attributes used in the eventual index. For the first time within quality of life measurement for economic evaluation, a best-worst scaling exercise has been used to estimate general population values (albeit for the population of those aged 65+ years) for the levels of attributes, with values anchored at one for full capability and zero for no capability. Death was assumed to be a state in which there is no capability. The values obtained indicate that attachment is the attribute with greatest impact but all attributes contribute to the total estimation of capability. Values that were estimated are feasible for use in practical applications of the index to measure the impact of health and social care interventions.

  • 11. Eli, Karin
    et al.
    Howell, Kyndal
    Fisher, Philip
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    A question of balance: Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Rationale: Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied.

    Objective: The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives.

    Methods: We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity.

    Results: The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status.

    Conclusions: Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions.

  • 12.
    Eliason, Marcus
    et al.
    Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Storrie, Donald
    Job loss is bad for your health - Swedish evidence on cause-specific hospitalization following involuntary job loss2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 8, p. 1396-1406Article in journal (Refereed)
    Abstract [en]

    This paper examines the impact of job loss on a number of non-fatal health events, which are nonetheless severe enough to require hospital in-patient care. We focus on job loss due only to establishment closures, as this reduces the problem of distinguishing between causation and selection. Using linked employee-employer register data, we identify the job losses due to all establishment closures in Sweden in 1987 or 1988. During a subsequent 12-year period, we find that job loss significantly increases the risk of hospitalization due to alcohol-related conditions, among both men and women, and due to traffic accidents and self-harm, among men only. We find no evidence, however, that job loss increased the risk of severe cardiovascular diseases such as myocardial infarction or stroke.

  • 13. Engström, Karin
    et al.
    Mattson, Fredrik
    Järleborg, Anders
    Hallqvist, Johan
    Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
    Contextual social capital as a risk factor for poor self-rated health: a multilevel analysis2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 11, p. 2268-2280Article in journal (Refereed)
    Abstract [en]

    In this study, we critically examine whether contextual social capital (CSC) is associated with self-rated health, with an emphasis on the problem of confounding. We also examine different components of CSC and their association with self-rated health. Finally, we look at differences in susceptibility between different socio-demographic groups. We use the cross-sectional base line study of the Stockholm Public Health Cohort, conducted in 2002. A postal questionnaire was answered by 31,182 randomly selected citizens, 18-84 years old, in Stockholm County. We used four measures of social capital: horizontal (civic trust and participation), vertical (political trust and participation), cognitive (civic and political trust) and structural (civic and political participation). CSC was measured at parish level from aggregated individual data, and multilevel regression procedures were employed. We show a twofold greater risk of poor self-rated health in areas with very low CSC compared with areas with very high CSC. Adjustments for individual socio-demographic factors, contextual economic factors and individual social capital lowered the excess risk. Simultaneous adjustment for all three forms of confounding further weakened the association and rendered it insignificant. Cognitive and structural social capital show relatively similar associations with self-rated health, while horizontal CSC seems to be more strongly related to self-rated health than vertical CSC. In conclusion, whether there is none or a moderate association between CSC and self-rated health, depends on the extent to which individual social capital is seen as a mediator or confounder. The association with self-rated health is similar independent of the measure of CSC used. It is also similar in different socio-demographic groups.

  • 14.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Starrin, Bengt
    Trustful bonds: A key to "becoming a mother" and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 1, p. 70-80Article in journal (Refereed)
    Abstract [en]

    A preterm birth and subsequent hospitalization of an infant at a neonatal unit (NU) implies an extraordinary life situation for mothers, in which the maternal role and breastfeeding begin and evolve in a medical and unfamiliar setting. Descriptions of how women experience “becoming a mother” and breastfeeding in such a situation are sparse and this question was addressed in the present study. In this qualitative study, inspired by the grounded theory approach, in-depth interviews were conducted with 25 mothers whose very preterm infants had been cared for in seven NUs in Sweden. Findings indicated the importance of quality in social bonds with the infant, father, staff and other mothers at the NU, for “becoming mothers” and experiencing mutually satisfying breastfeeding. Three themes comprised a structure for descriptions of experiences, social bonds and mediated emotions: (1) ‘loss’ of the infant and the emotional chaos—“putting life on hold”; (2) separation—a sign of being unimportant as a person and mother; and (3) critical aspects of becoming more than a physical mother. The qualities were described as trustful or distrustful, characterized by accompanying feelings of pride/trust or shame/distrust. Social bonds were affected not only by the interpersonal interplay but also by the public environment and care routines. In conclusion, the contextual setting and distrustful social bonds impaired the ability to “become mothers” and the sensation of reciprocity i.e. breastfeeding becoming dutiful and not mutually satisfying. As breastfeeding is an intimate interplay and a personal choice it was considered that the best breastfeeding support would seem to be provision of a favorable environment that enhances the mother's confidence in herself. The contextual setting should be modeled such as to create conditions for a trustful and reciprocal mother–infant bond.

  • 15.
    Flacking, Renée
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Starrin, Bengt
    "I wanted to do a good job": Experiences of 'becoming a mother' and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 64, no 12, p. 2405-2416Article in journal (Refereed)
    Abstract [en]

    In mothers of preterm infants, the process of becoming a mother is initiated in a public and medical environment, in which the mothers become dependent on the benevolence and support of the staff. This setting and an experience of insecure social bonds impair the ability to become a mother during the infant's stay at the neonatal unit (NU), and breastfeeding may become a duty and not be mutually satisfying. Studies on how women experience becoming a mother and breastfeeding after the infant's discharge are sparse and this question is addressed in the present grounded theory study. Twenty five mothers, whose very preterm infants had received care in seven NUs in Sweden, were interviewed once, 1–12 months after discharge. We propose a model to increase understanding of the process of becoming a mother and breastfeeding, after the infant's discharge from the NU. The mother's emotional expressions in this process showed pendular swings from feeling emotionally exhausted to feeling relieved, from experiencing an insecure to a secure bond, and from regarding breastfeeding as being non-reciprocal to being reciprocal. Unresolved grief, the institutional authority at the NU and experiences of shame were three of the central barriers to a secure and reciprocal relationship. The pendular changes give us a deeper understanding of the variations in both attachment and attunement. Perhaps the negative extremes are more prominent among these mothers on account of their infant's illness and their NU experiences. If our proposed model is valid, it is vital that these findings are considered by those involved in the short- and long-term care in order to support the mothers to establish a secure bond, comprising both attachment and attunement.

  • 16.
    Flynn, Terry Nicholas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Louviere, Jordan J
    Peters, Tim J
    Coast, Joanna
    Using discrete choice experiments to understand preferences for quality of life. Variance-scale heterogeneity matters.2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 12, p. 1957-65Article in journal (Refereed)
    Abstract [en]

    Health services researchers are increasingly using discrete choice experiments (DCEs) to model a latent variable, be it health, health-related quality of life or utility. Unfortunately it is not widely recognised that failure to model variance heterogeneity correctly leads to bias in the point estimates. This paper compares variance heterogeneity latent class models with traditional multinomial logistic (MNL) regression models. Using the ICECAP-O quality of life instrument which was designed to provide a set of preference-based general quality of life tariffs for the UK population aged 65+, it demonstrates that there is both mean and variance heterogeneity in preferences for quality of life, which covariate-adjusted MNL is incapable of separating. Two policy-relevant mean groups were found: one group that particularly disliked impairments to independence was dominated by females living alone (typically widows). Males who live alone (often widowers) did not display a preference for independence, but instead showed a strong aversion to social isolation, as did older people (of either sex) who lived with a spouse. Approximately 6-10% of respondents can be classified into a third group that often misunderstood the task. Having a qualification of any type and higher quality of life was associated with smaller random component variances. This illustrates how better understanding of random utility theory enables richer inferences to be drawn from discrete choice experiments. The methods have relevance for all health studies using discrete choice tasks to make inferences about a latent scale, particular QALY valuation exercises that use DCEs, best-worst scaling and ranking tasks.

  • 17.
    Fredriksson, Mio
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Consequences of a decentralized healthcare governance model: measuring regional authority support for patient choice in Sweden2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 2, p. 271-279Article in journal (Refereed)
    Abstract [en]

    What are the implications of a decentralized model of healthcare governance? This case study on patient choice in Sweden is an attempt to shed light on this issue. Due to decentralization and constitutional rights of self-determination, the regional authorities in Sweden, called County Councils (CCs), have far-reaching rights to manage the healthcare sector. The fact that patient choice is considered to be a soft law or a soft governance regulation, opens it up to regional variation. To examine the CCs level of support of patient choice, an index is presented. The Patient Choice Index (PCI) shows that there is extensive variation among the CCs. To explain the causes of these variations, a number of hypotheses are tested. The analyses imply that ideology and economy, and more specifically the CCs' governing majorities and running net profits, are major explanations for the level of support. A number of conclusions can be drawn from the results of this study. In short, the CCs appear to act according to a local point of view, which means that there is no functioning national patient choice standard, and thus patients do not have equal access to healthcare and patients' rights are unevenly distributed. Furthermore, the CCs' financial conditions and governing majorities seem to undermine equivalent reform realization in a national context. In summary, the results of this study emphasize the conflict between regional self-governance and national equality, which is particularly visible in the decentralized Swedish healthcare model.

  • 18. Fritze, Thomas
    et al.
    Doblhammer, Gabriele
    van den Berg, Gerard J.
    Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Can individual conditions during childhood mediate or moderate the long-term cognitive effects of poor economic environments at birth?2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 119, p. 240-248Article in journal (Refereed)
    Abstract [en]

    Recent analyses revealed that the business cycle at the time of birth influences cognitive functioning at older ages, and that those individuals born during economic boom periods on average display better cognitive functioning later in life. The current study examines the impact of childhood conditions on late-life cognitive functioning and investigates whether they mediate or moderate the effects of the business cycle at the time of birth. The underlying purpose is to find potential starting points for societal interventions that may counterbalance the negative long-term outcomes of adverse living conditions early in life. We use data from 7935 respondents at ages 60+ in eleven European countries from the first three waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). The survey data was collected in 2004, 2006/07, and 2008/09. Country fixed-effects models are used to examine the impact of macro-economic deviations in the year of birth and the indicators of childhood circumstances on late-life cognitive functioning. This study shows that the effects of boom and recession periods at birth are not simply mediated or moderated by living conditions during childhood. Conditions at birth have biological long-run effects on late-life cognitive functioning. Individuals born during boom periods display signs of having better cognitive functioning later in life, whereas recessions negatively influence cognition. Furthermore, a series of childhood conditions in and of themselves influence late-life cognition. Good childhood cognition, high education as well as a high social status, favourable living arrangements, and good health have a positive impact. Policy interventions should aim at a better access to school or measures to improve the economic and social situations of disadvantaged households.

  • 19. Grewal, Ini
    et al.
    Lewis, Jane
    Flynn, Terry
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Brown, Jackie
    Bond, John
    Coast, Joanna
    Developing attributes for a generic quality of life measure for older people: preferences or capabilities?2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 8, p. 1891-901Article in journal (Refereed)
    Abstract [en]

    Current UK policy with respect to the provision of health and social care for older people suggests that greater integration is required. Economists' attempts to assist resource allocation decisions, however, are very health focused, with concentration on the use of health-related quality of life measures. This paper reports an attempt to determine attributes for a new index clearly focusing on quality of life for older people rather than health or other influences on quality of life. In-depth interviews were conducted with 40 purposively selected informants aged 65 and over in private households to explore their views about what is important to them in terms of quality of life. Data were analysed using Framework qualitative analysis. Initial discussions tended to concentrate upon factors influencing quality of life including activities, relationships, health, wealth and surroundings. Further probing and analysis suggested five conceptual attributes: attachment, role, enjoyment, security and control. The data also suggested that the quality of informants' lives was limited by the loss of ability to pursue these attributes. So, for example, it is not poor health in itself, which reduces quality of life, but the influence of that poor health upon each informant's ability to, say, be independent, that is important. Amartya Sen's work on functioning and capability is particularly pertinent here. Using this work, it is possible to interpret the five conceptual attributes as a set of functionings-important for older people in the UK in the 21st century-but noting that it is the capacity to achieve these functionings that appears to be of importance. This suggests that further development of this measure should focus on an index of capability rather than preference-based utility.

  • 20.
    Gustafsson, Per E.
    et al.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hammarström, Anne
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Socioeconomic disadvantage in adolescent women and metabolic syndrome in mid-adulthood: an examination of pathways of embodiment in the Northern Swedish Cohort2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 10, p. 1630-1638Article in journal (Refereed)
    Abstract [en]

    Research indicates that disadvantaged socioeconomic status in childhood or adolescence increases specifically women's risk for developing metabolic syndrome in adulthood. Construing this observation as an expression of embodiment, the present study aims at examining the 'social chain of risk' and the 'reproduction' hypotheses as pathways of this embodiment. Participants were all women in the Northern Swedish Cohort, a 27-year prospective Swedish cohort, with data collection in 1981 at age 16 years (n = 1083, 506 women), and follow-up at age 21, 30 and 43 (n = 482 women) years. The analytical sample was n = 399 women (79% of the original cohort). Socioeconomic disadvantage was defined as parental manual occupation at age 16, and metabolic syndrome according to standardized criteria at age 43. The social chain of risk was operationalized as accumulated social and material adversities at age 16, 21, 30 and 43 years, and reproductive factors by age at menarche, early childbearing (before age 22), and number of children at age 43. In logistic regression with metabolic syndrome as the outcome, the OR for adolescent socioeconomic status was rendered non-significant and reduced by 21.6% after adjustment for cumulative adversity over the life course. Of the reproductive factors, only age at menarche lead to an OR reduction at all (by 43%). Our study suggests that women's embodiment of socioeconomic disadvantage during upbringing is partly explained by adversity over the subsequent life course. Future studies should incorporate the living conditions of women over the life course as a possible pathway whereby early life socioeconomic conditions are embodied. (C) 2012 Elsevier Ltd. All rights reserved.

  • 21.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Diderichsen, F
    Theorell, T
    Reuterwall, C
    Ahlbom, A
    Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).1998In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 46, no 11, p. 1405-15Article in journal (Refereed)
    Abstract [en]

    The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

  • 22.
    Hallqvist, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy.
    Lynch, John
    Bartley, Mel
    Lang, Thierry
    Blane, David
    Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program.2004In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 58, no 8, p. 1555-62Article in journal (Refereed)
    Abstract [en]

    The accumulation hypothesis would propose that the longer the duration of exposure to disadvantaged socio-economic position, the greater the risk of myocardial infarction. However there may be a danger of confounding between accumulation and possibly more complex combinations of critical periods of exposure and social mobility. The objective of this paper is to investigate the possibility of distinguishing between these alternatives. We used a population based case-control study (Stockholm Heart Epidemiology Programme) of all incident first events of myocardial infarction among men and women, living in the Stockholm region 1992-94. The analyses were restricted to men 53-70 years, 511 cases and 716 controls. From a full occupational history each subject was categorized as manual worker or non-manual at three stages of the life course, childhood (from parent's occupation), at the ages 25-29 and 51-55, resulting in 8 possible socio-economic trajectories. We found a graded response to the accumulation of disadvantaged socio-economic positions over the life course. However, we also found evidence for effects of critical periods and of social mobility. A conceptual analysis showed that there are, for theoretical reasons, only a limited number of trajectories available, too small to form distinct empirical categories of each hypothesis. The empirical task of disentangling the life course hypotheses of critical period, social mobility and accumulation is therefore comparable to the problem of separating age, period, and cohort effects. Accordingly, the interpretation must depend on prior knowledge of more specific causal mechanisms.

  • 23.
    Hammarström, Anne
    et al.
    Umeå universitet, Allmänmedicin.
    Janlert, Urban
    Umeå universitet, Epidemiologi och folkhälsovetenskap.
    Health selection in a 14-year follow-up study--a question of gendered discrimination?2005In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 61, no 10, p. 2221-32Article in journal (Refereed)
  • 24. Hemmingsson, Tomas
    et al.
    v Essen, Jan
    Melin, Bo
    Allebeck, Peter
    Lundberg, Ingvar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Arbets- och miljömedicin.
    The association between cognitive ability measured at ages 18-20 and coronary heart disease in middle age among men: a prospective study using the Swedish 1969 conscription cohort.2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 65, no 7, p. 1410-1419Article in journal (Refereed)
    Abstract [en]

    An association between childhood cognitive ability measured with IQ-tests and coronary heart disease (CHD) incidence has been reported recently. It is not clear from those studies to what extent the increased relative risk associated with lower cognitive ability may be explained by CHD risk factors. This study aims to investigate the association between cognitive ability measured at age 18-20 and incidence of CHD, acute myocardial infarction (AMI), and stroke among middle aged men adjusting for risk factors for CHD over the life course. Data on cognitive ability, and other risk factors for CHD (height, parental cardiovascular diseases (CVD) mortality, blood pressure, smoking, risky use of alcohol, BMI), were collected from 49,321 men, born in 1949-51, at conscription for compulsory military training in 1969/70 in Sweden. Information on socioeconomic factors in childhood (socioeconomic position and crowded housing) and adulthood (education, socioeconomic position, and income), as well as information on mortality and morbidity, was collected through national registers. Cognitive ability showed an inverse and graded association with CHD incidence. Adjustment for indicators of poor childhood circumstances, behavioural factors measured in late adolescence, and adult social circumstances strongly attenuated the increased risks of CHD and AMI. The contribution from adult social circumstances, after adjustment from all other factors, was very small. After adjustment for all risk factors no significantly increased relative risk was seen for stroke incidence. After adjustment for risk factors over the life course, the risk of CHD and AMI associated with cognitive ability decreased substantially, and was of borderline significance. Given the results from this study it is unlikely that cognitive ability is a risk factor on its own for CHD, AMI and stroke among men below 54 years of age.

  • 25. Isacson, D
    et al.
    Carsjö, K
    Haglund, B
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Psychotropic drug use in a Swedish community: Patterns of individual use during 2 years1988In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 27, no 3, p. 263-67Article in journal (Refereed)
    Abstract [en]

    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.

  • 26.
    Isaksson, Joakim
    et al.
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden..
    Salander, Par
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden..
    Lilliehorn, Sara
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden.;Umea Univ, Dept Radiat Sci Oncol, S-90187 Umea, Sweden..
    Laurell, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Living an everyday life with head and neck cancer 2-2.5 years post-diagnosis - A qualitative prospective study of 56 patients2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, p. 54-61Article in journal (Refereed)
    Abstract [en]

    Rationale: There are many studies available describing how patients are affected by head and neck cancer (HNC) and its treatment. Usually these studies are quantitative and focus on assessing patients' quality of life or distress post-treatment. These studies are important, but they are of limited value if we are interested in understanding more about HNC in an everyday life context. Objective: The purpose was to determine how life was lived and valued during and after treatment for HNC and to detect different transitions in returning to everyday life. Methods: During 2009-2012, 56 patients with HNC were consecutively included, and interviewed at 6, 12, and 24 months post-treatment about how they lived their lives. All patients received primary treatment at a tertiary referral university hospital in Sweden. Results: Four different trajectories and transitions emerged. The first group (n = 15) evaluated their illness experience as a past parenthesis in their life suggesting that they had psychologically left the illness behind. In the second group (n = 9), the impact of the disease seemed to be diluted by other strains in their life, and although these patients to some extent were still hampered by side effects, they regarded them as `no big deal'. The cancer really made a difference in the third group (n = 12) in both positive and negative ways and seemed to reflect a balance between such effects. In the fourth group (n = 20), the physical and/or psychological problems predominated and the patients' lives had changed for the worse. Conclusion: The narratives showed that being afflicted by HNC has different impacts depending on how the patients live their lives it is a matter of individual transition in an everyday life context. This idiosyncrasy challenges the meaningfulness of screening efforts to identify vulnerable groups for psychosocial intervention.

  • 27.
    Jukkala, Tanya
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Mäkinen, Ilkka
    Kislitsyna, Olga
    Ferlander, Sara
    Vågerö, Denny
    Economic strain, social relations, gender, and binge drinking in Moscow.2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 3, p. 663-674Article in journal (Refereed)
  • 28.
    Kälvemark, Sofia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Höglund, Anna T.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerholm, Peter
    Arnetz, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Living with conflicts: Ethical dilemmas and moral distress in the health care system2004In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 58, no 6, p. 1075-1084Article in journal (Refereed)
  • 29. Lancsar, Emily
    et al.
    Louviere, Jordan
    Flynn, Terry
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Several methods to investigate relative attribute impact in stated preference experiments.2007In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 64, no 8, p. 1738-53Article in journal (Refereed)
    Abstract [en]

    There is growing use of discrete choice experiments (DCEs) to investigate preferences for products and programs and for the attributes that make up such products and programs. However, a fundamental issue overlooked in the interpretation of many choice experiments is that attribute parameters estimated from DCE response data are confounded with the underlying subjective scale of the utilities, and strictly speaking cannot be interpreted as the relative "weight" or "impact" of the attributes, as is frequently done in the health economics literature. As such, relative attribute impact cannot be compared using attribute parameter size and significance. Instead, to investigate the relative impact of each attribute requires commensurable measurement units; that is, a common, comparable scale. We present and demonstrate empirically a menu of five methods that allow such comparisons: (1) partial log-likelihood analysis; (2) the marginal rate of substitution for non-linear models; (3) Hicksian welfare measures; (4) probability analysis; and (5) best-worst attribute scaling. We discuss the advantages and disadvantages of each method and suggest circumstances in which each is appropriate.

  • 30.
    Landstedt, Evelina
    et al.
    Umeå universitet, Epidemiologi och global hälsa.
    Almquist, Ylva B.
    Eriksson, Malin
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 135-143Article in journal (Refereed)
    Abstract [en]

    The present paper analysed the directions of associations between individual-level structural social capital, in the form of civic engagement, and depressive symptoms across time from age 16-42 years in Swedish men and women. More specifically, we asked whether civic engagement was related to changes in depressive symptoms, if it was the other way around, or whether the association was bi-directional. This longitudinal study used data from a 26-year prospective cohort material of 1001 individuals in Northern Sweden (482 women and 519 men). Civic engagement was measured by a single-item question reflecting the level of engagement in clubs/organisations. Depressive symptoms were assessed by a composite index. Directions of associations were analysed by means of gender-separate cross-lagged structural equation models. Models were adjusted for parental social class, parental unemployment, parental health, and family type at baseline (age 16). Levels of both civic engagement and depressive symptoms were relatively stable across time. The model with the best fit to data showed that, in men, youth civic engagement was negatively associated with depressive symptoms in adulthood, thus supporting the hypothesis that involvement in social networks promotes health, most likely through provision of social and psychological support, perceived influence, and sense of belonging. Accordingly, interventions to promote civic engagement in young men could be a way to prevent poor mental health for men later on in life. No cross-lagged effects were found among women. We discuss this gender difference in terms of gendered experiences of civic engagement which in turn generate different meanings and consequences for men and women, such as civic engagement not being as positive for women's mental health as for that of men. We conclude that theories on structural social capital and interventions to facilitate civic engagement for health promoting purposes need to acknowledge gendered life circumstances. (C) 2016 Elsevier Ltd. All rights reserved.

  • 31.
    Linander, I
    et al.
    Umeå Universitet.
    Alm, E
    Göteborgs universitet.
    Hammarström, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Harryson, L
    Umeå universitet.
    Negotiating the (bio)medicalgaze – Experiences of trans-specific healthcare in Sweden.2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 174, p. 9-16Article in journal (Refereed)
  • 32.
    Litorp, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mgaya, Andrew
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mbekenga, Columba K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kidanto, Hussein L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Fear, Blame And Transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 143, p. 232-240Article in journal (Refereed)
    Abstract [en]

    In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5-6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital's CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have.

  • 33. Modin, Bitte
    et al.
    Vågerö, Denny
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Koupil, Ilona
    The contribution of parental and grandparental childhood social disadvantage to circulatory disease diagnosis in young Swedish men2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 4, p. 822-834Article in journal (Refereed)
    Abstract [en]

    Men born out of wedlock in early twentieth century Sweden who never married have previously been shown to have a doubled mortality risk from ischaemic heart disease compared to the corresponding group of men born to married parents. This study further explores the question of childhood social disadvantage and its long-term consequences for cardiovascular health by examining the two subsequent generations. The question posed is whether the sons and grandsons of men and women born out of wedlock in early twentieth century Sweden have an increased risk of circulatory disease compared with the corresponding descendants of those born inside marriage. We examined this by use of military conscription data. The material used is the Uppsala Birth Cohort Multigenerational database consisting of individuals born at Uppsala University Hospital between 1915 and 1929 (UG1), their children (UG2) and grandchildren (UG3). Conscription data were available for UG2s born between 1950 and 1982 (n=5,231) and UG3s born between 1953 and 1985 (n=10,074) corresponding to 72.1% and 73.6%, respectively, of all males born in each time-period. Logistic regression showed that significant excess risk of circulatory disease diagnoses was present only among descendants of men born outside marriage, with sons and grandsons demonstrating odds ratios of 1.64 and 1.83, respectively, when BMI and height at the time of conscription, father's social class in mid-life and father's or grandfather's history of circulatory disease had been adjusted for. Separate analyses showed that the effect of the maternal and paternal grandfather was of approximately the same magnitude. Further analyses revealed an interaction between the father's social class and the grandfather's legitimacy status at birth on UG3-men's likelihood of having a circulatory disease, with elevated odds only among those whose fathers were either manual workers or self-employed. The results of this study suggest that social disadvantage in one generation can be linked to health disadvantage in the subsequent two generations

  • 34.
    Norberg, Annika Lindahl
    et al.
    Karolinska institutet, inst f kvinnors och barns hälsa.
    Lindblad, Frank
    Boman, Krister K
    Coping strategies in parents of children with cancer.2005In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 60, no 5, p. 965-75Article in journal (Refereed)
    Abstract [en]

    This study examined 395 parents (224 mothers and 171 fathers) of children with cancer in Sweden in terms of coping, assessed using the Utrecht Coping List. The use of each of seven coping strategies among parents of children with cancer was compared with data from parents of children with no serious or chronic diseases. In addition, the relationship between coping strategies and anxiety/depression was examined. No differences in the frequency of using the seven coping strategies were found between the study group and the reference group. Neither did the use of coping strategies differ among parents of children with various types of cancer, nor among parents at various points in time after the child's cancer diagnosis. A more frequent use of active problem-focusing, and a less frequent use of avoidance behaviour and passive reaction pattern, was related to lower levels of anxiety and depression in parents of children with cancer and in reference parents. Analyses of parents of children at different time points after diagnosis and in different diagnostic groups indicated that contextual demands influence the relation between coping and anxiety/depression.

  • 35.
    Norman, Armando H.
    et al.
    Durham University.
    Russell, Andrew J.
    Durham University.
    Merli, Claudia
    Durham University.
    The Quality and Outcomes Framework: Body commodification in UK General Practice2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 170, p. 77-86Article in journal (Refereed)
    Abstract [en]

    The UK's Quality and Outcomes Framework (QOF) is the largest pay-for-performance scheme in the world. This ethnographic study explored how QOF's monetary logic influences the approach to healthcare in UK general practice. From August 2013 to April 2014, we researched two UK general practice surgeries and one general practice training programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients' biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF's pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy.

  • 36.
    Sanner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Attitudes toward organ donation and transplantation: a model for understanding reactions to medical procedures after death1994In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 38, no 8, p. 1141-1152Article in journal (Refereed)
    Abstract [en]

    The main purpose of this study was to reach a deeper understanding of factors influencing the attitudes toward organ donation and other procedures with the dead body.

    From a survey of 400 inhabitants of Uppsala, a city in the middle of Sweden, concerning attitudes toward transplantation issues, 38 individuals with different attitudes toward donation of their own organs were selected for follow-up interviews. From the interviews, more than 600 statements concerning motives and reactions to medical procedures with the dead body were listed. These statements were summarized in 20 motive categories, in which 17 the nature of the motives were negative to organ donation and three promoting such a procedure. The categories were then analyzed and interpreted within a frame of reference of psychodynamic defense theory. In several cases it was possible to relate them to common death anxiety defenses. Six different motive complexes were extracted. These are called (1) illusion of lingering life; (2) protection of the value of the individual; (3) distrust, anxiety and alienation; (4) respecting the limits set by Nature or God; (5) altruism; and (6) rationality.

    Individuals not willing to donate their own organs were judged as either (a) reacting out of strenthened death anxiety defenses, or (b) as having a special outlook on life, where the idea of what is ‘natural’ was emphasized. The adverse reactions of the positive attitude group were seen as initial reactions perceived as derivations of common death anxiety defenses and weakened when confronted with altruistic and fact-stressing arguments.

    In the ‘undecided group’ of 14 persons, 11 arrived at a definite opinion. Seven decided for organ donation when their mistaken beliefs were corrected or when they took time to work through their initial uneasiness, while 4 persons actually were clearly negative. Three still remained uncertain.

    The stability of these attitudes seems to be high, often being experienced as a part of one's philiosophy of life.

  • 37.
    Sanner, Margareta A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Exchanging spare-parts or becoming a new person?: People's attitudes toward receiving and donating organs2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 52, no 10, p. 1491-1499Article in journal (Refereed)
    Abstract [en]

    The present study explored the public's feelings and ideas about receiving organs, and how this influenced their attitudes toward accepting a transplant themselves. Also the willingness to donate was examined in order to provide a complementary perspective. The main aim was to identify consistent attitude patterns that would include attitudes toward both receiving and donating organs and the motives behind this. Sixty-nine individuals with varying socio-demographic background, selected from samples who had responded to a questionnaire on receiving and donating organs and tissues, were interviewed in-depth. The approach to analyse the interviews was hermeneutic. Seven typical attitude patterns emerged. By an ‘attitude pattern’ was meant a specific set of attitudes and motives, that formed a consistent picture that was logical and psychologically meaningful.

    In the discussion, two different conceptions of the body were focused. One of them meant that the body was easily objectified and conceived as machine-like, and did not represent the self. This machine model paved the way for the understanding that body parts needed to be replaced by spare parts. The other conception meant that a new organ would transfer the donor's qualities, i.e. influence the identity of the recipient with regard to behaviour, appearance, and personality. This belief may be explained by ‘analogy thinking’ based on our everday experience of how mixed entities take on the qualities of all components. Another explanation would be a kind of magical thinking and ‘the law of contagion’, which is often connected to oral incorporation. The consequences of these conceptions when patients are confronted with the factual situation of a transplantation, were discussed.

  • 38. Schmidt, IK
    et al.
    Claesson, Cecilia B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerholm, B
    Svarstad, BL
    Resident characteristics and organizational factors influencing the quality of drug use in Swedish nursing homes1998In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 47, no 7, p. 961-971Article in journal (Refereed)
    Abstract [en]

    Appropriateness of drug use is an important indicator of the quality of care in nursing homes. In this study, we analyzed the influence of resident characteristics and selected organizational factors on the appropriateness of psychotropic drug use in 33 Swedish nursing homes. Specific criteria based on published guidelines and recommendations were developed to measure appropriateness. Residents diagnosed with a psychiatric disorder and younger residents had more deviations from the criteria; however, resident mix did not explain variations in appropriateness of drug use at the facility level. Facilities with better nurse staffing and drug intervention teams had fewer deviations from the criteria, but only 15–20% of the variation in drug prescribing was explained by these predictors.

  • 39.
    Stolt, Ragnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Privatization of social services: Quality differences in Swedish elderly care2011In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 72, no 4, p. 560-567Article in journal (Refereed)
    Abstract [en]

    One of the major policy trends in recent decades has been the privatization of social services. This trend has also reached Sweden, a welfare state with health care and social service sectors that previously had almost no private providers. One of the most affected areas is elderly care, i.e. home-help services and residential care provided to citizens older than 65 years, where the proportion of private providers increased from 1% in 1990 to 16% in 2010. The ongoing privatization in Sweden and many other countries has raised important questions regarding the consequences of this policy transformation. In this paper, we present a cross-sectional study comparing the quality of services in private and public elderly care. Using statistics from 2007 displaying a variety of quality dimensions covering over 99% of all elderly care residents in Sweden, we were able to show that privatization is indeed associated with significant quality differences. Structural quality factors such as the number of employees per resident was significantly smaller (-9%) in private elderly care. On the other hand, the proportion of residents participating in the formulation of their care plan (+7%), the proportion of elderly with a reasonable duration between evening meal and breakfast (+15%), and the proportion of elderly offered different food alternatives (+26%) were significantly in favour of private contractors. Our conclusion is that private care providers seem to emphasize service aspects rather than structural prerequisites for good care.

  • 40.
    Stolt, Ragnar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Mechanisms behind privatization: a case study of private growth in Swedish elderly care2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 5, p. 903-911Article in journal (Refereed)
    Abstract [en]

    For many years the Swedish Welfare State has been associated with a welfare model in which the public sector dominates both the provision and financing of the elderly care system. However, influenced by the ongoing trend of New Public Management, the past 15 years have been characterized by governmental regimes encouraging competition and as a result there has been a substantial increase in private providers. This case study on elderly care in Sweden provides new insights into the mechanisms behind the spread and growth of privatization. Our results show that in 1990 only 1% of the labour force in the elderly care sector was employed by private organizations, in comparison to 2003 when the private share had increased to 13%. The accompanying organizational changes have been controversial and are often criticized. In general, left-wing politicians have frequently defended the traditional welfare model dominated by public providers, whereas right-wing politicians have urged for a larger share of alternative providers. In this study, statistics between the years 1990 and 2003 were used to model the relationship between privatization and a number of economic, political and social/demographic variables. The results from regression and diffusion analysis imply that privately managed elderly care has established itself mainly in metropolitan areas dominated by right-wing regimes. Surprisingly, neighbouring municipalities tend to follow these pioneers irrespective of their political colour or economic situation. In fact, after shifting political power many of those neighbouring municipalities dominated by left-wing regimes not only maintain an abundance of private contractors but also encourage a continued process of contracting out publicly managed elderly care units. As a result, clusters of municipalities with an increasing degree of privatization arise despite political and economic differences. In conclusion, geographical proximity seems to be an important variable in addition to population density, ideology and financial situation when privatization reforms are implemented in the Swedish elderly care system.

  • 41.
    Wallman, Thorne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centrum för klinisk forskning i D län (CKFD).
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Do disability pensioners have a higher mortality rate than non-pensioners? Adjusting for potential confounding: A commentary on Hult, Stattin, Janlert and Jarvholm2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1487-1488Article in journal (Other academic)
  • 42.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Do physicians care about patient choice?2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 10, p. 1502-1511Article in journal (Refereed)
    Abstract [en]

    A new policy (patient choice) was introduced in Sweden in the early 1990s to give patients the right to choose their healthcare providers, however, evaluations show that few patients exercise this right. This paper analyses physicians' roles in putting the patient choice policy into effect. To examine attitudes, knowledge and behaviour among physicians, a questionnaire was sent to 960 physicians in one of the most populous counties in Sweden. The results show that the physicians approve of the policy, yet only a minority state that they regularly help patients to choose healthcare providers by giving them information and letting them choose where they will be referred. Instead, referrals are mostly based on medical grounds; the patient's wish to choose a specific provider is considered less important. In summary, we found that more than a decade after the policy was introduced, only a minority of physicians act according to the political intention. This could be one explanation for why many patients still do not exercise their right to choose a hospital.

  • 43.
    Witteveen, Anke B.
    et al.
    Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands.
    Bisson, Jonathan I.
    School of Medicine, Cardiff University, Cardiff, United Kingdom.
    Ajdukovic, Dean
    Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
    Arnberg, Filip K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Bergh Johannesson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Bolding, Hendrieke B.
    Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands.
    Elklit, Ask
    National Center of Psychotraumatology, Institute of Psychology, University of Southern Denmark, Odense, Denmark.
    Jehel, Louis
    Fort de France University Hospital Center, Antilles-Guyane University, Fort de France, Martinique.
    Johansen, Venke A.
    Resource Center on Violence, Traumatic Stress and Suicide prevention, Western Norway (RVTS West), Haukeland University Hospital, Norway.
    Lis-Turlejska, Maja
    Warsaw School of Social Sciences and Humanities, Warsaw, Poland.
    Nordanger, Dag O.
    Centre for Child and Adolescent Mental Health, Bergen, Norway.
    Orengo-Garcia, Francisco
    Sociedad Española de Psicotraumatología y Estrés Traumatico (SEPET), Madrid, Spain.
    Polak, A. Rosaura
    Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands.
    Punamaki, Raija-Leena
    School of Social Sciences and Humanities/ Psychology, University of Tampere, Finland.
    Schnyder, Ulrich
    Department of Psychiatry, University Hospital Zurich, Switzerland.
    Wittmann, Lutz
    Department of Psychiatry, University Hospital Zurich, Switzerland.
    Olff, Miranda
    Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands.
    Post-disaster psychosocial services across Europe: the TENTS project2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 9, p. 1708-1714Article in journal (Refereed)
    Abstract [en]

    At present post-disaster activities and plans seem to vary widely. An adequate estimation of the availability of post-disaster psychosocial services across Europe is needed in order to compare them with recently developed evidence-informed psychosocial care guidelines. Here we report on the results of a cross-sectional web-based survey completed in 2008 by two hundred and eighty-six representatives of organizations involved in psychosocial responses to trauma and disaster from thirty-three different countries across Europe. The survey addressed planning and delivery of psychosocial care after disaster, methods of screening and diagnosis, types of interventions used, and other aspects of psychosocial care after trauma. The findings showed that planning and delivery of psychosocial care was inconsistent across Europe. Countries in East Europe seemed to have less central coordination of the post-disaster psychosocial response and fewer post-disaster guidelines that were integrated into specific disaster or contingency plans. Several forms of psychological debriefing, for which there is no evidence of efficacy to date, were still used in several areas particularly in North Europe. East European countries delivered evidence-based interventions for PTSD less frequently, whilst in South- and South-Eastern European countries anxiety suppressing medication such as benzodiazepines were prescribed more frequently to disaster victims than in other areas. Countries across Europe are currently providing sub-optimal psychosocial care for disaster victims. This short report shows that there is an urgent need for some countries to abandon non-effective interventions and others to develop more evidence based and effective services to facilitate the care of those involved in future disasters.

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