Articles de revues : « National health services – Sweden »

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Wennergren, Mattias, Karin Berg, Ann-Sofie Frisk Cavefors, Helena Edin, Leif Ekholm, Lars Gelander, Marie Golsäter et al. « Swedish Child Health Services Register : a quality register for child health services and children’s well-being ». BMJ Paediatrics Open 7, n^o 1 (janvier 2023) : e001805. http://dx.doi.org/10.1136/bmjpo-2022-001805.

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BackgroundSwedish child health services (CHS) is a free-of-charge healthcare system that reaches almost all children under the age of 6. The aim for the CHS is to improve children’s physical, psychological and social health by promoting health and development, preventing illness and detecting emerging problems early in the child’s life. The services are defined in a national programme divided into three parts: universal interventions, targeted interventions and indicated interventions.The Swedish Child Health Services Register (BHVQ) is a national Quality Register developed in 2013. The register extracts data from the child’s health record and automatically presents current data in real time. At present, the register includes 21 variables.AimWe aim to describe data available in the BHVQ and the completeness of data in BHVQ across variables.MethodsChild-specific data were exported from the register, and data for children born in the regions were retrieved from Statistics Sweden to calculate coverage.ResultsThe register includes over 110 000 children born between 2011 and 2022 from 221 child healthcare centres in eight of Sweden’s 21 regions. In seven of the eight regions, 100% of centres report data.The completeness of data differs between participating regions and birth cohorts. The average coverage for children born in 2021 is 71%.ConclusionsThe BHVQ is a valuable resource for evaluating Child Health Services nationally, with high coverage for the youngest children. As a result of continuous improvement of the services, the possibility to follow the development of children’s health in Sweden is possible through the register. When fully expanded, the register will be a natural and essential part of developing preventive services, improving healthcare for children below 6 years of age and a tool for developing evidence-based child health interventions.

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Dahlgren, Göran, et Finn Diderichsen. « Strategies for Equity in Health : Report from Sweden ». International Journal of Health Services 16, n^o 4 (octobre 1986) : 517–37. http://dx.doi.org/10.2190/27k4-dhk1-cdcb-9p94.

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In recent years the Swedish debate on health policy has been focusing on resource allocation between primary care versus secondary care, private care versus public care, and prevention versus care. The National Commission on the “Swedish Health Services in the 1990s” brought attention to the prevailing inequalities in health. The Health Policy Bill of 1985 defines the reduction of inequalities in health as a major target of national health policy. The health policy measures discussed are mainly outside the health care sector.

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Wagenius, Cecilia M., Miguel San Sebastián, Per E. Gustafsson et Isabel Goicolea. « Access for all ? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden ». Scandinavian Journal of Public Health 47, n^o 1 (19 mai 2018) : 1–8. http://dx.doi.org/10.1177/1403494818774965.

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Background: Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden. Methods: The study used data from the Health on Equal Terms survey (age group 16–24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables. Results: Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services. Conclusions: These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.

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Burström, Bo. « What Is Happening in Sweden ? » International Journal of Health Services 49, n^o 2 (14 janvier 2019) : 204–11. http://dx.doi.org/10.1177/0020731418822236.

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Election to the parliament was held in Sweden on 9 September 2018. None of the traditional political blocks obtained a majority of the vote. The nationalist Sweden Democrats party increased their share of the vote from 13% in 2014 elections to 17% of the vote in 2018. As no traditional political block wants to collaborate with the Sweden Democrats, no new government has yet been formed, more than 2 months after the election. Health care was a prominent issue in the elections. Health care in Sweden is universal and tax-funded, with a strong emphasis on equity. However, recent reforms have emphasized market-orientation and privatization in order to increase access to care, and may not contribute to equity. In spite of a majority of the population being opposed to profits being made on publicly funded services, privatization of health and social care has increased in the last decades. The background to this is described. Health is improving in Sweden, but inequalities remain and increase. The Swedish Public Health Policy from 2003 has been revised in 2018, on the basis of a national review of inequalities in health. The revised policy further emphasizes reducing inequalities in health.

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Manhica, H., Y. Almquist, M. Rostila et A. Hjern. « The use of psychiatric services by young adults who came to Sweden as teenage refugees : a national cohort study ». Epidemiology and Psychiatric Sciences 26, n^o 5 (29 juin 2016) : 526–34. http://dx.doi.org/10.1017/s2045796016000445.

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Aims.To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers.Method.Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population.Results.Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86–4.10) and 1.89 (1.53–2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34–1.94) and 1.37 (1.25–1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12–7.46) and 3.07 (1.52–6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17–2.06) and 1.84 (1.37–2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06–7.29) for unaccompanied refugees and 2.04 (1.51–2.73) for accompanied refugees.Conclusions.Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.

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Arat, Arzu, Marie Norredam, Ulrike Baum, Stefán Hrafn Jónsson, Geir Gunlaugsson, Thomas Wallby et Anders Hjern. « Organisation of preventive child health services : Key to socio-economic equity in vaccine uptake ? » Scandinavian Journal of Public Health 48, n^o 5 (17 mai 2019) : 491–94. http://dx.doi.org/10.1177/1403494819850430.

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Background: Measles has made a comeback in Western Europe, with more cases being reported each year. One factor behind this development is low vaccination coverage in socially disadvantaged segments of the population in many countries. This study investigates whether socioeconomic patterns of uptake of the measles, mumps and rubella (MMR) vaccine in the Nordic countries differ by national organisation of preventive health services for children. Methods: MMR vaccine uptake before the age of two years was analysed in register data from Denmark, Finland, Iceland and Sweden, linked to family indicators of socio-economic status (SES) from national registers. Results: Denmark, a country where child vaccinations are administered by general practitioners, presented the lowest overall coverage of MMR at 83%. It also had the greatest difference between subpopulations of low and high SES at 14 percentage points. Finland, Iceland and Sweden, countries where preschool children are vaccinated in ‘well-baby’ clinics, had a higher overall coverage at 91–94%, with a more equal distribution between SES groups at 1–4 percentage points. Conclusions: This study suggests that the organisation of preventive health care in special units, ‘well-baby’ clinics, facilitates vaccine uptake among children with low SES in a Nordic welfare context.

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Sundström, Gerdt, Magnus Jegermalm, Antonio Abellán, Alba Ayala, Julio Pérez, Rogelio Pujol et Javier Souto. « Men and older persons also care, but how much ? Assessing amounts of caregiving in Spain and Sweden ». International Journal of Ageing and Later Life 12, n^o 1 (13 août 2018) : 75–90. http://dx.doi.org/10.3384/ijal.1652-8670.17356.

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We estimate how much caregiving men and women respectively do, and how much of the caregiving is done by older (65+) and younger persons, inside their household and for other households, in Spain and in Sweden. To assess this, we use self-reported hours of caregiving from two national surveys about caregiving, performed in 2014 (Spain, N = 2003; Sweden, N = 1193). Spain and Sweden have dissimilar household structures, and different social services for older (65+) persons. Caregivers, on average, provide many more hours of care in Spain than in Sweden. Women provide about 58% of all hours of caregiving, in Spain in all age groups, in Sweden only among younger caregivers. The reason is the dominance of partner caregivers among older Swedes, with older men and women providing equal hours of care. Family caregiving inside the household is more extensive in the more complex Spanish households than in Swedish households. Family care between households prevails in Sweden, where the large majority of older persons live with a partner only, or alone. This is increasingly common in Spain, although it remains at a lower level. We estimate that older persons provide between 22% and 33% of all hours of caregiving in Spain, and between 41% and 49% in Sweden. Patterns of caregiving appear to be determined mainly by demography and household structure.

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Kulling, Per E. J., et Jonas E. A. Holst. « Educational and Training Systems in Sweden for Prehospital Response to Acts of Terrorism ». Prehospital and Disaster Medicine 18, n^o 3 (septembre 2003) : 184–88. http://dx.doi.org/10.1017/s1049023x00001035.

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AbstractSweden has a long tradition in planning for disaster situations in which the National Board of Health and Welfare has a key responsibilty within the health sector. One important part of this disaster preparedness is education and training. Since 11 September 2001, much focus has been placed on the acts of terrorism with special reference to the effects of the use of chemical, biological, or nuclear/radiological (CBNR) agents. In the health sector, the preparedness for such situations is much the same as for other castastrophic events. The National Board of Health and Welfare of Sweden is a national authority under the government, and one of its responsibilities is planning and the provision of supplies for health and medical services, environmental health, and social services in case of war or crises. “Joint Central Disaster Committees” in each County Council/Region in the country are responsible for overseeing major incident planning for their respective counties/regions. The “Disaster Committee” is responsible for ensuring that: (1) plans are established and revised; (2) all personnel involved in planning receive adequate information and training; (3) equipment and supplies are available; and (4) maintenance arrangements are in place.Sweden adopts a “Total Defense” strategy, which means that it places a high value in preparing for peacetime and wartime major incidents. The Swedish Emergency Management Agency coordinates the civilian Total Defense strategy, and provides funding to the relevant responsible authority to this end. The National Board of Health and Welfare takes responsibility in this process. In this area, the main activities of the National Board of Health and Welfare are: (1) the establishment of national guidelines and supervision of standards in emergency and disaster medicine, social welfare, public health, and prevention of infectious diseases; (2) the introduction of new principles, standards, and equipment; (3) the conducting education and training programmes; and (4) the provision of financial support. The budget for National Board of Health and Welfare in this area is approximately 160 million SEK (US$18 million). The National Board of Health and Welfare also provides funding to the County Councils/Regions for the training of healthcare professionals in disaster medicine and crises management by arranging (and financing) courses primarily for teachers and by providing financial support to the County Councils/Regions for providing their own educational and training programmes. The National Board of Health and Welfare provides funding of approximately 20 million SEK (US$2.4 million) to the County Councils/Regions for this training of healthcare professionals in disaster medicine and crises.

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Ghatnekar, Ola, Ulf Persson, Kjell Asplund et Eva-Lotta Glader. « COSTS FOR STROKE IN SWEDEN 2009 AND DEVELOPMENTS SINCE 1997 ». International Journal of Technology Assessment in Health Care 30, n^o 2 (avril 2014) : 203–9. http://dx.doi.org/10.1017/s0266462314000075.

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Objectives: The aim of this study was to estimate direct and indirect excess costs attributable to stroke in Sweden in 2009 and to compare these with similar estimates from 1997.Methods: Data on first-ever stoke admissions in the first half of 2009 from the Swedish national stroke register (RS) were used for cost calculations and compared with results from 1997 also using RS data. A societal perspective was taken including the acute and follow-up phase, rehabilitation, stroke re-admissions, drugs, home- and residential care services for activities of daily life (ADL) support, and indirect costs for premature death and productivity losses (2009 prices). Survival was extrapolated to estimate the lifetime present value cost of stroke.Results: The societal lifetime present value cost for stroke in 2009 was €68,800 per patient (ADL support: 59 percent; productivity losses: 21 percent). Women had higher costs than men in all age groups as a result from greater need for ADL support. Patients treated at a stroke unit indicated low incremental cost per life-year gained compared with those who had not. The total lifetime cost increased between 1997 and 2009. Hospitalization costs per patient were stable, while long-term costs for home- and residential care services increased.Conclusions: Changes in patient characteristics, longer expected survival, and possibly in the Swedish stroke care, have led to higher annual and lifetime costs per patient in 2009 compared with 1997. A comprehensive national stroke care performance register like RS may be suitable for health economic assessments.

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Øvretveit, John, Patricia Ramsay, Stephen M. Shortell et Mats Brommels. « Comparing and improving chronic illness primary care in Sweden and the USA ». International Journal of Health Care Quality Assurance 29, n^o 5 (13 juin 2016) : 582–95. http://dx.doi.org/10.1108/ijhcqa-02-2016-0014.

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Purpose – The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach – A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings – There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden’s established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications – There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value – The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.

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Brunt, David, et Lena Tibblin. « Supported housing and housing support for the psychiatrically disabled – Background, population, policies, practices and current challenges ». Aotearoa New Zealand Social Work 23, n^o 1-2 (8 juillet 2016) : 54–65. http://dx.doi.org/10.11157/anzswj-vol23iss1-2id169.

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This article presents an overview of the development of supported housing and housing support for the psychiatrically disabled in Sweden as well as a short résumé of the major policies, reforms and agencies that have influenced this development, in particular the Mental Health Care reform of 1995 and the National Agency for the Co-ordination of Psychiatric Services. Characteristics of the residents and residences are described. The specific role of the care assessment officer in the light of three case examples is discussed and the current challenges facing the providers of housing and support for the psychiatrically disabled in Sweden are presented.

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Garg, Aditi, Dimitrios Skempes et Jerome Bickenbach. « Legal and Regulatory Approaches to Rehabilitation Planning : A Concise Overview of Current Laws and Policies Addressing Access to Rehabilitation in Five European Countries ». International Journal of Environmental Research and Public Health 17, n^o 12 (18 juin 2020) : 4363. http://dx.doi.org/10.3390/ijerph17124363.

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Background: The rising prevalence of disability due to noncommunicable diseases and the aging process in tandem with under-prioritization and underdevelopment of rehabilitation services remains a significant concern for European public health. Over recent years, health system responses to population health needs, including rehabilitation needs, have been increasingly acknowledging the power of law and formal written policies as strategic governance tools to improve population health outcomes. However, the contents and scope of enacted legislation and adopted policies concerning rehabilitation services in Europe has not been synthesized. This paper presents a concise overview of laws and policies addressing rehabilitation in five European countries. Methods: Publicly available laws, policies, and national action plans addressing rehabilitation issues of Sweden, Italy, Germany, the Netherlands and the United Kingdom were reviewed and descriptive documents analyzed. Actions found in national health policies were also evaluated for compliance with the key recommendations specified in the World Health Organization’s Rehabilitation 2030: Call for Action. Results: Across countries, legal and policy approaches to rehabilitation planning varied in scope and reach. While all countries entitle citizens to rehabilitation services, comprehensiveness of coverage varied. Health legislation of Germany and Netherlands recognizes access to rehabilitation as a human right for persons with disabilities, while Sweden and the United Kingdom acknowledge its importance in disability laws for achieving substantive equality for persons with disabilities. Regarding policies, in all countries but Italy, targeted universalism remains the predominant strategy governing rehabilitation services, as demonstrated by the lack of comprehensive, national action plans for rehabilitation addressing the general population. Nevertheless, references found in disease specific policies indicate a solid consensus that rehabilitation remains an integral component of the care continuum for those experiencing disability. Conclusion: Although a universal approach to rehabilitation coverage is institutionalized in national legislation of the countries examined, this approach is not expressed in formal policies. Targeted strategies aiming to ensure access to subpopulation groups with higher perceived needs for rehabilitation prevail, indicating a strong political will towards the reduction of health inequalities and the promotion of human rights of people experiencing disability. Results obtained from conducting this descriptive review provide the basis for future appraisals of the situation regarding rehabilitation service and policy development in Europe.

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Ghatnekar, Ola, Ulf Persson, Eva-Lotta Glader et Andreas Terént. « Cost of stroke in Sweden : An incidence estimate ». International Journal of Technology Assessment in Health Care 20, n^o 3 (août 2004) : 375–80. http://dx.doi.org/10.1017/s0266462304001217.

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Objectives:To estimate the excess cost of stroke in Sweden and the potential costs that could be avoided by preventing first-ever strokes.Methods:We adopted the incidence approach for estimating the present value of both direct and indirect costs. Data on mortality, stroke recurrence, and inpatient care were estimated from a national register of patient data with a four-year follow-up period. To estimate costs for social services, we used survey data on living conditions before stroke onset and at three and at twenty-four months. Costs for outpatient visits, rehabilitation, drugs, and production losses due to premature death and early retirement were estimated on the basis of both published and nonpublished sources. Lifetime costs were based on life tables adjusted for excess mortality of stroke, and costs in year 4 were extrapolated to subsequent years.Results:The present value direct cost for an average stroke patient is SEK513,800 (US$56,024 or Euro60,825). The corresponding indirect cost is SEK125,110 (US$13,640 or Euro14,810). Almost 45 percent of the direct costs were attributable to social services. Women had higher costs than men, and costs for survivors increased with age due to social services.Conclusions:With an incidence of 213 first-ever strokes per 100,000 individuals, the total excess direct and indirect cost of stroke would be SEK12.3 billion (approximately US$1.3 billion or Euro1.5 billion). Hence, there are large potential cost offsets both in the health-care sector and in the social service sector if the incidence of first-ever stroke could be reduced.

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Westerlund, Tommy, et Bertil Marklund. « Community pharmacy and primary health care in Sweden - at a crossroads ». Pharmacy Practice 18, n^o 2 (2 mai 2020) : 1927. http://dx.doi.org/10.18549/10.18549/pharmpract.2020.2.1927.

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The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

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Westerlund, Tommy, et Bertil Marklund. « Community pharmacy and primary health care in Sweden - at a crossroads ». Pharmacy Practice 18, n^o 2 (2 mai 2020) : 1927. http://dx.doi.org/10.18549/pharmpract.2020.2.1927.

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The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

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Borg, Erik A., et Kjell Ljungbo. « International market-oriented strategies for medical tourism destinations ». International Journal of Market Research 60, n^o 6 (19 avril 2018) : 621–34. http://dx.doi.org/10.1177/1470785318770134.

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Patients seeking medical care are traveling greater distances for treatment. The globalization of health care has given rise to a thriving global medical services industry. The ability to gain access to more advanced treatments and differences in cost and inflexible national health care systems encourage patients to seek treatment abroad. In the new information age, patients seek information about available treatment opportunities with less regard to national boundaries. International hospitals are seeking new marketing strategies for their services. Today, much of the marketing takes place on the Internet, which is accelerating the internationalization of the medical services industry. This article presents a comparative and interpretative study. We have interpreted the market orientation and degree of specialization of hospitals in Singapore and in Sweden, which in turn are compared to leading hospitals in the United States. In this research, we present evidence of different approaches to medical tourism based on different organizational frameworks for the marketing of medical services to international patients. The study indicates that market orientation results in greater emphasis on superior service quality of health care. This in turn leads to the delivery of improved services to patients.

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Silfvast, Tom, et Tomi Pekkonen. « Inter-Authority and Cross-Border Cooperation Using the Tetra Digital Radio Network ». Prehospital and Disaster Medicine 34, s1 (mai 2019) : s141—s142. http://dx.doi.org/10.1017/s1049023x19003133.

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Introduction:The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.Methods:The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.Results:Pending configuration of necessary talk groups, the system will be functional and in use in 2019.Discussion:Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.

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Eriksson, Irene, Björn Wettermark, Marie Persson, Morgan Edström, Brian Godman, Anna Lindhé, Rickard Malmström, Helena Ramström, Mia von Euler et Anna Bergkvist-Christensen. « VP18 Early Awareness And Alert System In Sweden : History And Current Status ». International Journal of Technology Assessment in Health Care 33, S1 (2017) : 154–55. http://dx.doi.org/10.1017/s0266462317003117.

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INTRODUCTION:Over the past decades, early awareness and alert (EAA) activities and systems have gained importance and become a key early Health Technology Assessment (HTA) tool. While a pioneer in HTA, Sweden had no national level EAA activities until recently. We describe the evolution and current status of the Swedish EAA System.METHODS:This was a historical analysis based on the knowledge and experience of the authors supplemented by a targeted review of published and grey literature, as well as documents produced by or relating to the Swedish EAA System. Key milestones and a description of the current state of the Swedish EAA System are presented.RESULTS:Initiatives to establish a system for the identification and assessment of emerging health technologies in Sweden date back to the 1980s. Since the 1990s, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) supported the development of EuroScan and was one of its founding members. In the mid-2000s, an independent regional initiative, driven by the Stockholm Drug and Therapeutics Committee, resulted in the establishment of a regional horizon scanning unit. By 2009, this work had expanded to a collaboration between the four biggest regions in Sweden. The following year it was further expanded to the national level. Today, the Swedish EAA System carries out identification, filtration and prioritization of new drugs, early assessment of the prioritized drugs, and dissemination of the information. Its outputs are used to select new drugs for inclusion in the Swedish national process for managed introduction and follow-up.CONCLUSIONS:The Swedish EAA System started as a regional initiative and rapidly grew to become a national level activity. An important feature of the system today is its complete integration into the national process for managed introduction and follow-up of new drugs. The system will continue to evolve as a response both to the changing landscape of health innovations and to new policy initiatives at the regional, national and international levels.

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Abellan, Antonio, Julio Perez, Rogelio Pujol, Gerdt Sundström, Magnus Jegermalm et Bo Malmberg. « Partner care, gender equality, and ageing in Spain and Sweden ». International Journal of Ageing and Later Life 11, n^o 1 (27 mars 2017) : 69–89. http://dx.doi.org/10.3384/ijal.1652-8670.16-305.

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We used national surveys to study how older persons’ changing household patterns influence the gender balance of caregiving in two countries with distinct household structures and cultures, Spain and Sweden. In both countries, men and women provide care equally often for their partner in couple-only households. This has become the most common household type among older persons in Spain and prevails altogether in Sweden. This challenges the traditional dominance of young or middle-aged women as primary caregivers in Spain. In Sweden, many caregivers are old themselves. We focus attention to partners as caregivers and the consequences of changing household structures for caregiving, which may be on the way to gender equality in both countries, with implications for families and for the public services.

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Olsson, S., I. Andersson, I. Karlberg, N. Bjurstam, E. Frodis et S. Håkansson. « Implementation of service screening with mammography in Sweden : from pilot study to nationwide programme ». Journal of Medical Screening 7, n^o 1 (1 mars 2000) : 14–18. http://dx.doi.org/10.1136/jms.7.1.14.

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Establishment of mammography screening in Sweden has progressed logically from pilot study through clinical trials to service screening. Screening with mammography for early detection of breast cancer has been provided by all Sweden's 26 county councils since 1997. It took 23 years from the initial pilot study through clinical trials to the establishment of mammography service screening through out Sweden.In the screening rounds completed by 1995–96, and provided by all but one county council, 1 040 000 women participated, corresponding to 81% of those invited. The national average recall rate was 2.2%, and consequently 23 000 women were recalled for additional investigations. Eleven county councils invited women aged 40–74, six invited women aged 50–69, the remaining eight invited women between both these age intervals.Mammography outside screening programmes—clinical mammography—is available throughout Sweden. About 100 000 women a year were referred for clinical mammography and about 50% of these were either younger or older than those invited for screening. A negative relation between the use of clinical mammography and participation in the screening programmes was noticed.

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Orellana, Cecilia, Bertina Kreshpaj, Bo Burstrom, Letitia Davis, Paolo Frumento, Tomas Hemmingsson, Gun Johansson, Katarina Kjellberg, David H. Wegman et Theo Bodin. « Organisational factors and under-reporting of occupational injuries in Sweden : a population-based study using capture–recapture methodology ». Occupational and Environmental Medicine 78, n^o 10 (31 mars 2021) : 745–52. http://dx.doi.org/10.1136/oemed-2020-107257.

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ObjectiveTo estimate the magnitude of under-reporting of non-fatal occupational injuries (OIs) by different organisational factors in Sweden for the year 2013.MethodsCapture–recapture methods were applied using two data sources: (1) the national OI register and (2) records from a labour market insurance company. To assure comparability of data sources, the analysis was restricted to the public sector and private companies with at least 50 employees. OIs were matched using personal identification number and reported injury dates (±7 days). Organisational factors were obtained from the national labour market register and injury severity (no healthcare/only outpatient/hospitalised) from the National Patient Register. Total number of OIs and ascertainment by data sources were estimated assuming data source independence.ResultsThere were an estimated 98 493 OIs in 2013. Completeness of reporting OIs to the national register and to the insurance company was estimated at 73% and 43%, respectively. No report to either source was estimated at 15 000 OIs (~15%). Under-reporting to the national register differed by selected organisational factors, being higher among organisations in the public sector, those with more females, with a younger workforce and with a higher proportion of immigrants. Overall under-reporting was more common in agriculture (19.7%), other services (19.3%), commerce and hospitality (19.1%), health (18.4%) and education (18.4%). Under-reporting decreased as injury severity increased, with little variations across sectors of economic activity.ConclusionsResults suggest considerable under-reporting of OIs in Sweden and differential under-reporting by organisational factors. Results are relevant for official estimates of burden and for setting priorities for workplace safety and prevention.

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Saltman, Richard B. « The impact of slow economic growth on health sector reform : a cross-national perspective ». Health Economics, Policy and Law 13, n^o 3-4 (24 janvier 2018) : 382–405. http://dx.doi.org/10.1017/s1744133117000445.

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AbstractThis paper assesses recent health sector reform strategies across Europe adopted since the onset of the 2008 financial crisis. It begins with a brief overview of the continued economic pressure on public funding for health care services, particularly in tax-funded Northern European health care systems. While economic growth rates across Europe have risen a bit in the last year, they remain below the level necessary to provide the needed expansion of public health sector revenues. This continued public revenue shortage has become the central challenge that policymakers in these health systems confront, and increasingly constrains their potential range of policy options. The paper then examines the types of targeted reforms that various European governments have introduced in response to this increased fiscal stringency. Particularly in tax-funded health systems, these efforts have been focused on two types of changes on the production side of their health systems: consolidating and/or centralizing administrative authority over public hospitals, and revamping secondary and primary health services as well as social services to reduce the volume, cost and less-than-optimal outcomes of existing public elderly care programs. While revamping elderly care services also was pursued in the social health insurance (SHI) system in the Netherlands, both the Dutch and the German health systems also made important changes on the financing side of their health systems. Both types of targeted reforms are illustrated through short country case studies. Each of these country assessments flags up new mechanisms that have been introduced and which potentially could be reshaped and applied in other national health sector contexts. Reflecting the tax-funded structure of the Canadian health system, the preponderance of cases discussed focus on tax-funded countries (Norway, Denmark, Sweden, Finland, England, Ireland), with additional brief assessments of recent changes in the SHI-funded health systems in the Netherlands and Germany. The paper concludes that post-2008 European reforms have helped stretch existing public funds more effectively, but seem unlikely to resolve the core problem of inadequate overall public funding, particularly in tax-based health systems. This observation suggests that ongoing Canadian efforts to consolidate and better integrate its health care providers, while important, may not eliminate long-term health sector-funding dilemmas.

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Kazemi, Ali, et Petri Kajonius. « Variations in user-oriented elderly care : a multilevel approach ». International Journal of Quality and Service Sciences 9, n^o 2 (19 juin 2017) : 138–47. http://dx.doi.org/10.1108/ijqss-06-2016-0045.

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Purpose National Board of Health and Welfare claims that the quality of elderly care services differ considerably between municipalities in Sweden. This study aims to analyze to what extent these variations can be accounted for by the older person’s municipality affiliation (i.e. receiving elderly care in a certain municipality). Design/methodology/approach Addressing this issue, national survey data from 78,538 older respondents receiving elderly care services in Sweden were analyzed using multilevel modeling (MLM). Findings The results showed that municipality affiliation only marginally explained the variance in satisfaction with care, i.e. its variations were larger within than between municipalities. Instead, user-oriented care accounted for the variation in satisfaction with care. Specifically, the way the care workers behave toward the older person proved to be much more crucial for satisfaction with care than municipality affiliation. Moreover, random effects analyses revealed that the effects of user-oriented care on satisfaction with care varied across municipalities. Care setting (i.e. home care or nursing home) only marginally accounted for its variance. Practical implications Developing care quality should start and primarily be discussed at the interpersonal care level, and not, as is customary, at the municipality level. Originality/value The present research is the first in its kind to quantitatively investigate the sources of variation in perceived quality of Swedish elderly care using MLM.

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Stewart, John. « Ideology and Process in the Creation of the British National Health Service ». Journal of Policy History 14, n^o 2 (avril 2002) : 113–34. http://dx.doi.org/10.1353/jph.2002.0013.

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The British National Health Service (NHS) was created shortly after the end of World War II and formally came into being on its “Appointed Day” in July 1948. The NHS has been seen as the crowning achievement of the postwar Labour government's “welfare state” by both the general public and academic commentators. As Rodney Lowe points out, by the late 1940s opinion polls showed it to be by far the best-received part of Labour's social policies; and in popular perceptions the terms “NHS” and “welfare state” were often viewed as synonymous. Lowe himself, while carefully noting the problems that attended the birth of the health service, nonetheless sees it as an “idealistic” institution and remarks that in no other Western country, not even social democratic Sweden, “were the whole population and the full range of medical need (Beveridge's principles of universalism and comprehensiveness) so quickly realized by a free service.” Another respected commentator, Rudolf Klein, similarly highlights the exceptionally wide-ranging remit of the NHS, claiming it as a “unique experiment in social engineering.”

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B. Jensen, Irene, Elisabeth Björk Brämberg, Charlotte Wåhlin, Christina Björklund, Ulric Hermansson, Malin Lohela Karlson, Liselotte Schäfer Elinder et al. « Promoting Evidence-Based Practice for Improved Occupational Safety and Health at Workplaces in Sweden. Report on a Practice-Based Research Network Approach ». International Journal of Environmental Research and Public Health 17, n^o 15 (22 juillet 2020) : 5283. http://dx.doi.org/10.3390/ijerph17155283.

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Despite the rapid growth in research and R&D expenditures, the translation of research into practice is limited. One approach to increase the translation and utilization of research is practice based research networks. With the aim of strengthening evidence-based practice (EBP) within occupational health services in Sweden (OH-Services), a practice-based research network (PBRN-OSH) was developed. The PBRN-OSH includes researchers and representatives from end-users. This paper reports on the development, outputs and lessons learned in the PBRN-OSH. The PBRN-OSH resulted in several practice-based research projects as well as different measures to ensure EBP in OSH such as the governmentally sanctioned national guidelines for the OH-services. Moreover, results show that the competence in EBP increased among practitioners at the OH-services. Conducting research in a PBRN is more resource demanding; however, this does not imply that it is less cost effective. To succeed in increasing the utility of research findings via PBRN, resources must be invested into an infrastructure that supports collaboration in the PBRN, including costs for a variety of means of dissemination. Further, translation activities need to be included in academic career paths and reward systems if a major improvement in the impact and return of investments from research is to be expected.

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McConachy, Tracy Herb, et Howard A. Palley. « Sweden's health care system : The delivery of health care services within a national/local system ». New Global Development 19, n^o 2 (juillet 2003) : 49–62. http://dx.doi.org/10.1080/17486830308415656.

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Sottas, Beat, Christiane Mentrup et Peter C. Meyer. « Interprofessional education and practice in Sweden / Interprofessionelle Bildung und Praxis in Schweden ». International Journal of Health Professions 3, n^o 1 (10 mai 2016) : 3–13. http://dx.doi.org/10.1515/ijhp-2016-0002.

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AbstractThere are some significant differences between the health systems in German speaking Europe and Sweden: In Sweden, the number of hospitals is small, caregiving services in the hospital and ambulatory sector are integrated, health professionals with university degrees are granted extended competencies and rights incl. first line consultation and limited prescription. Education is designed to prepare for these functions and responsibilities. It started more than 30 years ago when Linköping implemented the OECD-model of Health Universities. Interprofessional teaching, common learning of the various tracks and training on real patients are constitutive elements of this novel approach. Karolinska University in Stockholm adopted the model in 1998 and gave way to a nationwide reform. A recommendation of the German Science Council regarding training of health professionals, published 2012, drew the attention of educators to this approach. The paper explains the circumstances of the consolidation of this concept. It is important to realize that overarching governance principles and measures deriving from health and education policy are of crucial importance. They evolve from evaluations of needs carried out by the regional health agencies which lead to conditional mandates and financial incentives to the education sector. Moreover, decisions taken by the national board for accreditation and quality assurance take also in account the goals set and the outcomes in education and caregiving. Outside Sweden they would be considered an inappropriate limitation of academic freedom.The paper ends with a reflection of impressions collected during a study trip and shows some lessons to be learnt from the Swedish education and practice.

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Scandurra, Isabella, Anette Jansson, Marie-Louise Forsberg-Fransson et Ture Ålander. « Patient Accessible EHR is Controversial ». International Journal of Reliable and Quality E-Healthcare 6, n^o 1 (janvier 2017) : 29–45. http://dx.doi.org/10.4018/ijrqeh.2017010103.

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In Sweden, a national eHealth service providing Patient Accessible Electronic Health Records is now being widely deployed, with 400 000 users in January 2016. Although the Patient Data Act states that patients have a right to take part of their health records, the introduction has been controversial. Results from a pre-deployment questionnaire to record-keeping care professions in a healthcare region indicate that perceptions and knowledge differ not only between the professions but, more importantly, that knowledge about current eHealth development and action plans needs to increase as implementation will affect their work processes. Staff perceptions and knowledge are considered being some of the most important issues to handle during the implementation of eHealth services aiming to provide healthcare information and communication tools for patients and relatives. To cover the gaps, specific training is needed, and all record-keeping professionals need to be more involved in the implementation of such eHealth services.

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Järkestig Berggren, Ulrika, Kerstin Arnesson et Ann-Sofie Bergman. « The Take-off for Private Consultants in Child Protection Investigations—How Did Sweden Get Here ? » British Journal of Social Work 51, n^o 4 (12 mars 2021) : 1463–81. http://dx.doi.org/10.1093/bjsw/bcab053.

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Abstract The use of private consultants in child protection investigations in Sweden is an evolving practice that occurs under the radar; it is not in the political agenda and it is obscure in relation to legislation. The aim of this article is to analyse the contextual forces, facilitators and intentions behind the ongoing implementation of privatisation in child protection investigations. For this article, both quantitative and qualitative data for the years 2013–2017 were obtained through a telephone questionnaire. Managers of 32 social services departments were interviewed. Statistical data of the year 2018 collected by the National Board of Health and Welfare was also included in the analysis. Applying a mixed-method design, the article shows that some prerequisites in legislation make it possible for privatisation to develop. There are societal changes that act as contextual forces, and there are structures in place from earlier stages of the development of privatisation that facilitate the new practice. Also, there are professional intentions that drive the process. The implementation of private consultants in child protection takes place during a period of high workload for social services. The article concludes with a discussion about the consequences for children and families of this new trend in privatisation.

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Mucic, D. « Telemental health in treatment of ethnic minorities in EU ». European Psychiatry 26, S2 (mars 2011) : 2194. http://dx.doi.org/10.1016/s0924-9338(11)73897-4.

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Access to adequate mental health care services is one of the identified problems within EU mental health services. Increased migration into and within EU cause the increased demands for clinicians with selected skills.TeleMental Health applications could improve access to mental health care in rural, remote and under-served as well as in metropolitan areas all around EU. Telepsychiatry is the most common telemental health application. Furthermore, there are various internet based approaches to treatment of mental conditions on distance. Transcultural telepsychiatry model, developed in Denmark during last decade was aimed to treat ethnic minorities via their own mothertongue(s) by use of telepsychiatry. Patient satisfaction rapported within telepsychiatry service in Denmark is very high. The restricted physical contact and non-verbal communication of telepsychiatry compensates by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references.Ongoing international telepsychiatry collaboration established between Sweden and Denmark is a success that may be exported to other european countries. The experiences from this pioneer international transcultural telepsychiatry service may contribute to further development an European Telepsychiatry Network. However, this model may be used as an inspiration for conducting of larger international telepsychiatry service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue within EU.

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Dupraz, Julien, Karen Andersen-Ranberg, Stefan Fors, Marie Herr, Francois R. Herrmann, Tomoko Wakui, Bernard Jeune, Jean-Marie Robine, Yasuhiko Saito et Brigitte Santos-Eggimann. « Use of healthcare services and assistive devices among centenarians : results of the cross-sectional, international 5-COOP study ». BMJ Open 10, n^o 3 (mars 2020) : e034296. http://dx.doi.org/10.1136/bmjopen-2019-034296.

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ObjectivesTo measure the use of healthcare services and assistive devices by centenarians in five countries.DesignCross-sectional study using a survey questionnaire.SettingCommunity-dwelling and institutionalised centenarians living in Japan, France, Switzerland, Sweden and Denmark.Participants1253 participants aged 100 or in their 100th year of life, of whom 1004 (80.1%) were female and 596 (47.6%) lived in institutions.Main outcome measuresRecent use of medical visits, nursing care at home, home-delivered meals, acute care hospital stays overnight, professional assessments such as sight tests, mobility aids and other assistive devices. A set of national healthcare system indicators was collected to help interpret differences between countries.ResultsThere was considerable variability in the healthcare services and assistive devices used by centenarians depending on their country and whether they were community-dwelling or institutionalised. In contrast to the relatively homogeneous rates of hospitalisation in the past year (around 20%), community-dwelling centenarians reported widely ranging rates of medical visits in the past 3 months (at least one visit, from 32.2% in Japan to 86.6% in France). The proportion of community-dwellers using a mobility device to get around indoors (either a walking aid or a wheelchair) ranged from 48.3% in Japan to 79.2% in Sweden. Participants living in institutions and reporting the use of a mobility device ranged from 78.6% in Japan to 98.2% in Denmark.ConclusionsOur findings suggest major differences in care received by centenarians across countries. Some may result from the characteristics of national healthcare systems, especially types of healthcare insurance coverage and the amounts of specific resources available. However, unexplored factors also seem to be at stake and may be partly related to personal health and cultural differences.

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Lazarus, Jeffrey V., Adam Palayew, Kenneth Rabin, Katarzyna Wyka, Sonia Hajo, Scott Ratzan, Jonathan Fielding et Ayman El-Mohandes. « A cross-sectional study of the association of age, gender, education and economic status with individual perceptions of governmental response to COVID-19 ». BMJ Open 11, n^o 3 (mars 2021) : e047310. http://dx.doi.org/10.1136/bmjopen-2020-047310.

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ObjectiveWe assessed the impact of key population variables (age, gender, income and education) on perceptions of governmental effectiveness in communicating about COVID-19, helping meet needs for food and shelter, providing physical and mental healthcare services, and allocating dedicated resources to vulnerable populations.DesignCross-sectional study carried out in June 2020.Participants and setting13 426 individuals from 19 countries.ResultsMore than 60% of all respondents felt their government had communicated adequately during the pandemic. National variances ranged from 83.4% in China down to 37.2% in Brazil, but overall, males and those with a higher income were more likely to rate government communications highly. Almost half (48.8%) of the respondents felt their government had ensured adequate access to physical health services (ranging from 89.3% for Singapore to 27.2% for Poland), with higher ratings reported by younger and higher-income respondents. Ratings of mental health support were lower overall (32.9%, ranging from 74.8% in China to around 15% in Brazil and Sweden), but highest among younger respondents. Providing support for basic necessities of food and housing was rated highest overall in China (79%) and lowest in Ecuador (14.6%), with higher ratings reported by younger, higher-income and better-educated respondents across all countries. The same three demographic groups tended to rate their country’s support to vulnerable groups more highly than other respondents, with national scores ranging from around 75% (Singapore and China) to 19.5% (Sweden). Subgroup findings are mostly independent of intercountry variations with 15% of variation being due to intercountry differences.ConclusionsThe tendency of younger, better-paid and better-educated respondents to rate their country’s response to the pandemic more highly, suggests that government responses must be nuanced and pay greater attention to the needs of less-advantaged citizens as they continue to address this pandemic.

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Grandahl, Maria, Margareta Larsson et Björn Herrmann. « ‘To be on the safe side’ : a qualitative study regarding users’ beliefs and experiences of internet-based self-sampling for Chlamydia trachomatis and Neisseria gonorrhoeae testing ». BMJ Open 10, n^o 12 (décembre 2020) : e041340. http://dx.doi.org/10.1136/bmjopen-2020-041340.

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ObjectivesIn Sweden, an increasing number of tests for sexually transmitted infections are conducted. Self-sampling services are provided free of charge at the national eHealth website. Our aim was to obtain a deeper understanding of users’ beliefs and experiences of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) self-sampling services.MethodsThis qualitative study is part of the national project ‘Internet-based chlamydia and gonorrhoea self-sampling test’, conducted in Sweden. Individuals ordering a CT/NG self-sampling test at home from the eHealth website were invited to participate. Of the 114 individuals who agreed, a purposeful sample including 20 women and men aged 18–49 years (mean, 30.8 years) participated in a telephone interview in 2019.ResultsThe test service for CT/NG was highly appreciated by men and women of different ages. Round-the-clock accessibility, avoiding clinical visits, ease of use, confidentiality and a rapid test result were reasons for this appreciation. Language, uncertainty about the correct sampling procedure, unreliable postal services and concerns about handling of personal data were mentioned as barriers. Reasons for testing were checking after unprotected sex, symptoms, checking a partner’s fidelity or a regular routine—‘to be on the safe side’. Knowledge about the infections and their consequences was limited; some considered them severe, especially if they could threaten fertility, and others were less concerned. Disclosing an infection was described as emotionally stressful. Participants had high self-efficacy in relation to the test and would not hesitate to use the service again, even if it involved a cost.ConclusionsInternet-based CT/NG self-sampling at home was highly appreciated and was used for individual health reasons, but also out of concern for others’ health and for society as a whole. The benefits seem to outweigh the barriers, and the service may therefore continue to be widely offered.

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Malm, Desire, Linn Bishop, Per Gustafsson, Anna-Karin Waenerlund et Isabel Goicolea. « Validation of a questionnaire to measure youth-friendliness of Swedish youth clinics ». Scandinavian Journal of Public Health 45, n^o 4 (6 avril 2017) : 366–72. http://dx.doi.org/10.1177/1403494817699479.

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Aim: This study presents the validation process of a tool to assess the youth-friendliness of Swedish youth clinics, based on the Youth-Friendly Health Services – World Health Organization Plus (YFHS-WHO+) questionnaire but adapted to the specific context of differentiated services catering only for young people in this country. Methods: The validation process followed five steps: (1) translation, (2) revision by professionals, (3) pretests with young people, (4) back-translation and discussion with the developers of the original YFHS-WHO+ questionnaire and (5) internal consistency and test–retest reliability testing. Results: The final Swedish version, titled Youth-Friendly Health Services-Sweden (YFHS-Swe), differs from the original in terms of adjustments in language and in changes to make it better correspond to the reality of the Swedish youth clinics, while maintaining the meaning and intention of the original questionnaire. The YFHS-Swe questionnaire generated reproducible responses (test–retest coefficient of 0.79 for the total score) and can be considered a measure of a cohesive construct (Cronbach alpha of 0.95 for the total score). Conclusions: The study suggests that the YFHS-Swe questionnaire is a reliable instrument that can be an asset for youth clinics to evaluate their work and make regional and national comparisons between clinics. The YFHS-Swe could also serve as a basis for validating instruments to assess youth-friendliness of differentiated services for young people in other countries.

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The Swedish National Council for Su. « Support in Suicidal Crises : The Swedish National Program to Develop Suicide Prevention 1An English-language version of the full program may be ordered from the National Board of Health and Welfare, Customer Dept., S-106 30 Stockholm, Sweden, fax +46 8 663-9290, e-mail (Internet) kundtj@sos.se, tel. +46-8-783 30 03. Article No. 1996-00-84 or from The National Institute of Public Health�s distribution service, S-120 88 Stockholm, Sweden, fax +46 8 449-8811. » Crisis 18, n^o 2 (mars 1997) : 65–72. http://dx.doi.org/10.1027/0227-5910.18.2.65.

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The Swedish National Program to Develop Suicide Prevention was created through collaboration between the National Board of Health and Welfare, the National Institute of Public Health, and the Centre for Suicide Research and Prevention. These institutions aim to provide joint support for the development of suicide prevention in Sweden by, for example, encouraging educational and development project. The program was signed for the National Council for Suicide Prevention by Agneta Dreber, Director-General, National Institute of Public Health; Danuta Wasserman, Professor of Psychiatry and Suicidology, Head, National Centre for Suicide Research and Prevention; and Claes Örtendahl, Director-General, National Board of Health and Welfare. This article, edited by Jan Beskow, Professor of Psychiatry at the Centre for Suicide Research and Prevention, is an abridged version submitted to Crisis at the request of the Editors.

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Bravell, Marie Ernsth, Deborah G. Finkel et Linda Johansson. « HEALTH CARE AND SOCIAL CARE AMONG FRAIL OLDER ADULTS IN SWEDEN : A REGISTRY-BASED STUDY ». Innovation in Aging 3, Supplement_1 (novembre 2019) : S492. http://dx.doi.org/10.1093/geroni/igz038.1826.

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Abstract In 2010 the Swedish government made a large investment to improve the quality of care for the “frailest older adults” but there have been few follow-ups of the care of this group. The aim of this study is to therefore describe use of care over the time in 2010-2014. Methods: In 2014, 9 National Quality Registries, 3 Care Registries (drug-, patient and death-registers) and the registry for care and social services for older persons (SOL) were individually matched to an older population in the Swedish Twin Registry (n≈45000). Identification of the “frailest older adults” was achieved via SOL and the Patient Registry. Results: 280 persons were identified as “frailest” in 2010 these were followed over time. About two thirds (60,7%) were women, mean age: 81.2±7.7, about one third (35%) lived in a nursing home, one third (34%) had more than three hospitals stays, almost three quarters (72.5%) had more than 19 hospital days and almost one third (28%) had more than seven outpatient care visits. By the end of 2012, 119 persons (42.5%) were deceased. Among those alive (n=161) 42 persons did not receive any inpatient care between 2010-2012, but more than 85% received outpatient care and 44.1% were living in nursing homes. In 2014, 90 persons (32.1%) were still alive and half of them lived in a nursing home. In conclusion, over time the use of care as well as the risk of mortality was high confirming the need of further improvement of the care for these persons.

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Bülow, Per, Pia H. Bülow et Deborah Finkel. « DIFFERENCES AND SIMILARITIES OF ELDERLY PERSONS IN SWEDEN WITH A DIAGNOSIS OF PSYCHOSIS OR NON-PSYCHOSIS (SMI) ». Innovation in Aging 6, Supplement_1 (1 novembre 2022) : 794. http://dx.doi.org/10.1093/geroni/igac059.2867.

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Abstract Psychiatric care in Sweden is jointly organized by psychiatric practice and municipal social services. To determine who is entitled to support from the municipalities, the concept of “psychiatric disability” was created in connection with psychiatric reform in 1995. Psychiatric disability is a poorly identified concept and in Sweden, a person has severe mental illness (SMI) if they have difficulties in carrying out activities in crucial areas of life, these difficulties are caused by a mental disorder, and they are prolonged. Internationally, SMI is often synonymous with psychosis, but in Sweden other severe psychiatric conditions are included, but not dementia. Both practically and ethically, the unclear definition of SMI is a problem because it determines whether a person is granted interventions and what forms the interventions take. We investigated similarities and differences in people defined as SMI, divided into two groups, psychosis (Nf222) and non-psychosis (Nf253). Adults with SMI aged 65 or over (in 2016) have been assessed using data from four surveys carried out between 1996 and 2011, as well data available from national registers. People with psychosis had worse functional levels on the Global Assessment of Functioning and more unmet needs, according to Camberwell Assessment of Needs. However, differences between psychosis and non-psychosis groups varied across measures (e.g., education, income, living situation) and results differed depending on age at onset, year of first admission to a mental hospital, and length of institutionalization. These variables had a greater impact on the similarities and differences between measures than the diagnosis itself.

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Groeneveld, E. Iris, J. Brian Cassel, Claudia Bausewein, Ágnes Csikós, Malgorzata Krajnik, Karen Ryan, Dagny Faksvåg Haugen et al. « Funding models in palliative care : Lessons from international experience ». Palliative Medicine 31, n^o 4 (3 février 2017) : 296–305. http://dx.doi.org/10.1177/0269216316689015.

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Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

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Pedersen, Lasse, Roland Valori, Inge Bernstein, Karen Lindorff-Larsen, Charlotte Green et Christian Torp-Pedersen. « Risk of post-colonoscopy colorectal cancer in Denmark : time trends and comparison with Sweden and the English National Health Service ». Endoscopy 51, n^o 08 (7 juin 2019) : 733–41. http://dx.doi.org/10.1055/a-0919-4803.

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Abstract Background The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC. Methods National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC. Results The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95 % confidence interval [CI] 1.05 – 1.19) and Sweden (RR 1.15, 95 %CI 1.06 – 1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5 % in 2001 to 7.9 % in 2012. The multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95 %CI 2.88 – 3.66), ulcerative colitis (RR 3.44, 95 %CI 2.79 – 4.23), hereditary cancer (age < 60 years: RR 7.39, 95 %CI 5.77 – 9.47; age ≥ 60 years: RR 3.81, 95 %CI 2.74 – 5.31), and location in the transverse (RR 1.57, 95 %CI 1.28 – 1.94) and ascending colon (RR 1.85, 95 %CI 1.64 – 2.08). Conclusions The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr.

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Gonçalves-Pereira, M., M. J. Marques, C. Balsinha, T. Reis, A. Machado, H. Bárrios, L. Alves et al. « The Portuguese Participation in the Actifcare (Access to Timely Formal Care in Dementia) European Study : Preliminary Results of Systematic Reviews, Qualitative and Quantitative Data ». European Psychiatry 41, S1 (avril 2017) : S652. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1089.

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IntroductionIn the context of untimely access to community formal services, unmet needs of persons with dementia (PwD) and their carers may compromise their quality of life.Objectives/aimsThe Actifcare EU-JPND project (www.actifcare.eu) focuses on access to and (non) utilization of dementia formal care in eight countries (The Netherlands, Germany, United Kingdom, Sweden, Norway, Ireland, Italy, Portugal), as related to unmet needs and quality of life. Evaluations included systematic reviews, qualitative explorations, and a European cohort study (PwD in early/intermediate phases and their primary carers; n = 453 days; 1 year follow-up). Preliminary Portuguese results are presented here (FCT-JPND-HC/0001/2012).Methods(1) extensive systematic searches on access to/utilization of services; (2) focus groups of PwD, carers and health/social professionals; (3) prospective study (n = 66 days from e.g., primary care, hospital outpatient services, Alzheimer Portugal).ResultsIn Portugal, nationally representative data is scarce regarding health/social services utilization in dementia. There are important barriers to access to community services, according to users, carers and professionals, whose views not always coincide. The Portuguese cohort participants were 66 PwD (62.1% female, 77.3 ± 6.2 years, 55.5% Alzheimer's/mixed subtypes, MMSE 17.8 ± 4.8, CDR1 89.4%) and 66 carers (66.7% female, 64.9 ± 15.0 years, 56.1% spouses), with considerable unmet needs in some domains.ConclusionsAll Actifcare milestones are being reached. The consortium is now analyzing international differences in (un) timely access to services and its impact on quality of life and needs for care (e.g., formal community support is weaker in Portugal than in many European countries). National best-practice recommendations in dementia are also in preparation.Abstract submitted on behalf of the Actifcare Eu-JPND consortium.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Staffini, Alessio, Akiko Kishi Svensson, Ung-Il Chung et Thomas Svensson. « An Agent-Based Model of the Local Spread of SARS-CoV-2 : Modeling Study ». JMIR Medical Informatics 9, n^o 4 (6 avril 2021) : e24192. http://dx.doi.org/10.2196/24192.

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Background The spread of SARS-CoV-2, originating in Wuhan, China, was classified as a pandemic by the World Health Organization on March 11, 2020. The governments of affected countries have implemented various measures to limit the spread of the virus. The starting point of this paper is the different government approaches, in terms of promulgating new legislative regulations to limit the virus diffusion and to contain negative effects on the populations. Objective This paper aims to study how the spread of SARS-CoV-2 is linked to government policies and to analyze how different policies have produced different results on public health. Methods Considering the official data provided by 4 countries (Italy, Germany, Sweden, and Brazil) and from the measures implemented by each government, we built an agent-based model to study the effects that these measures will have over time on different variables such as the total number of COVID-19 cases, intensive care unit (ICU) bed occupancy rates, and recovery and case-fatality rates. The model we implemented provides the possibility of modifying some starting variables, and it was thus possible to study the effects that some policies (eg, keeping the national borders closed or increasing the ICU beds) would have had on the spread of the infection. Results The 4 considered countries have adopted different containment measures for COVID-19, and the forecasts provided by the model for the considered variables have given different results. Italy and Germany seem to be able to limit the spread of the infection and any eventual second wave, while Sweden and Brazil do not seem to have the situation under control. This situation is also reflected in the forecasts of pressure on the National Health Services, which see Sweden and Brazil with a high occupancy rate of ICU beds in the coming months, with a consequent high number of deaths. Conclusions In line with what we expected, the obtained results showed that the countries that have taken restrictive measures in terms of limiting the population mobility have managed more successfully than others to contain the spread of COVID-19. Moreover, the model demonstrated that herd immunity cannot be reached even in countries that have relied on a strategy without strict containment measures.

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Svärd, Veronica, et Kristina Alexanderson. « Physician’s use of sickness certification guidelines : a nationwide survey of 13 750 physicians in different types of clinics in Sweden ». BMJ Open 11, n^o 12 (décembre 2021) : e051555. http://dx.doi.org/10.1136/bmjopen-2021-051555.

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ObjectivesTo explore physicians’ experiences of using the national sickness certification guidelines introduced in 2007 and the types of information they used, in general and in different types of clinics.DesignCross-sectional survey.SettingMost physicians working in Sweden in 2017.ParticipantsA questionnaire was sent to 34 718 physicians; 54% responded. Analyses were based on answers from the 13 750 physicians who had sick leave cases.Outcome measuresTo what extent the guidelines were used and what type of information from them that was used.ResultsTen years after the sickness certification guidelines were introduced in Sweden, half of the physicians used them at least once a month. About 40% of physicians in primary healthcare and occupational health services used the guidelines every week. The type of information used varied; 53% used recommendations about duration and 29% about degree of sick leave. Using information about function and activity/work capacity, respectively, was more common within primary healthcare (37% and 38%), psychiatry (42% and 42%), and occupational health services (35% and 41%), and less common in surgery and orthopaedic clinics (12% and 12%) who more often used information about duration (48% and 53%). Moreover, 10% stated that the guidelines were very, and 24% fairly problematic to apply. Half (47%) stated that the guidelines facilitated their contacts with patients and 29% that they improved quality in their management of sick leave cases. More non-specialists, compared with specialists, found that the guidelines facilitated contacts with patients (OR 3.28, 95% CI 3.04 to 3.55).ConclusionsThe majority of the physicians used the sickness certification guidelines, although this varied with type of clinic. Half stated that the guidelines facilitated patient contacts. Yet, some found it problematic to apply the guidelines. Further development of the guidelines is warranted as well as more knowledge about them among physicians.

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Taibi, Mustapha. « Community interpreting and translation in the Arab World ». Babel. Revue internationale de la traduction / International Journal of Translation 60, n^o 1 (24 novembre 2014) : 52–69. http://dx.doi.org/10.1075/babel.60.1.04tai.

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Community interpreting and translation enable public service providers and users to communicate in situations where they do not share the same language. These professions are essential for social equity and egalitarian access to legal, health, education and other services. Many countries with significant numbers of migrants or autochthonous language minorities have developed more or less satisfactory services and standards in this burgeoning subfield of translation and interpreting. Instances can be identified of countries that have made significant progress (e.g., Australia, Canada and Sweden) as well as of those which started only recently (e.g., Spain and Italy). In Arab countries, however, one can hardly find a reference to this subfield of translation studies, although situations requiring such interpreting and translation services are numerous. This paper describes and raises awareness of the status quo of community interpreting and translation in the Arab World. Three examples are focused on: Morocco as a country with a national language minority, the United Arab Emirates, as an affluent country hosting migrants, and Saudi Arabia, a country with a special religious position which hosts millions of pilgrims every year. The paper also includes recommendations based on migration and pilgrimage statistics and the experiences of the pioneering countries above.

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Kjellström, Sofia, Kristina Areskoug-Josefsson, Boel Andersson Gäre, Ann-Christine Andersson, Marlene Ockander, Jacob Käll, Jane McGrath, Sara Donetto et Glenn Robert. « Exploring, measuring and enhancing the coproduction of health and well-being at the national, regional and local levels through comparative case studies in Sweden and England : the ‘Samskapa’ research programme protocol ». BMJ Open 9, n^o 7 (juillet 2019) : e029723. http://dx.doi.org/10.1136/bmjopen-2019-029723.

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IntroductionCocreation, coproduction and codesign are advocated as effective ways of involving citizens in the design, management, provision and evaluation of health and social care services. Although numerous case studies describe the nature and level of coproduction in individual projects, there remain three significant gaps in the evidence base: (1) measures of coproduction processes and their outcomes, (2) mechanisms that enable inclusivity and reciprocity and (3) management systems and styles. By focusing on these issues, we aim to explore, enhance and measure the value of coproduction for improving the health and well-being of citizens.Methods and analysisNine ongoing coproduction projects form the core of an interactive research programme (‘Samskapa’) during a 6-year period (2019–2024). Six of these will take place in Sweden and three will be undertaken in England to enable knowledge exchange and cross-cultural comparison. The programme has a longitudinal case study design using both qualitative and quantitative methods. Cross-case analysis and a sensemaking process will generate relevant lessons both for those participating in the projects and researchers. Based on the findings, we will develop explanatory models and other outputs to increase the sustained value (and values) of future coproduction initiatives in these sectors.Ethics and disseminationAll necessary ethical approvals will be obtained from the regional Ethical Board in Sweden and from relevant authorities in England. All data and personal data will be handled in accordance with General Data Protection Regulations. Given the interactive nature of the research programme, knowledge dissemination to participants and stakeholders in the nine projects will be ongoing throughout the 6 years. External workshops—facilitated in collaboration with participating case studies and citizens—both during and at the end of the programme will provide an additional dissemination mechanism and involve health and social care practitioners, policymakers and third-sector organisations.

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Bevan, Gwyn, et Wynand P. M. M. van de Ven. « Choice of providers and mutual healthcare purchasers : can the English National Health Service learn from the Dutch reforms ? » Health Economics, Policy and Law 5, n^o 3 (juillet 2010) : 343–63. http://dx.doi.org/10.1017/s1744133110000071.

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AbstractIn the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

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Sobis, Iwona. « Nothing but Trouble : Studies on the Effects of Reforms in Elderly Care in Sweden and Poland ». NISPAcee Journal of Public Administration and Policy 6, n^o 1 (1 juillet 2013) : 31–60. http://dx.doi.org/10.2478/nispa-2013-0002.

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Abstract Reforms of the public sector, conducted in the spirit of NPM since the 1990s, are frequently studied by Western and Eastern scholars. The research shows national variations in how the NPM idea was translated and adapted into a country’s context and regulations. Care for the elderly is an interesting example of reforms conducted in the spirit of NPM, because it relates to welfare and health care and to the competences of provincial and local authorities in most European countries. This paper addresses the following questions: What do we know about the reforms conducted in the spirit of NPM and its practical implication within the field of care for the elderly during 1990 - 2010? What kind of knowledge about care for the elderly is still missing and should be developed in the future ? Th is paper conducts comparative research on what is known about the effects of the Swedish and the Polish reforms regarding care for the elderly. It argues that most literature points to negative effects, but also to the fact that there are still gaps in our knowledge about the effects of reforms concerning elderly care, especially regarding its organization. Hence, despite all the research done, we do not know what kind of social and health-care services for seniors represent the best practices for the future.

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Ribeiro, Oscar, Lia Araújo, Daniela Figueiredo, Constança Paúl et Laetitia Teixeira. « The Caregiver Support Ratio in Europe : Estimating the Future of Potentially (Un)Available Caregivers ». Healthcare 10, n^o 1 (22 décembre 2021) : 11. http://dx.doi.org/10.3390/healthcare10010011.

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The caregiver support ratio (CSR) is defined as the number of potential caregivers aged 45–64 years, the most common caregiving age range, for each person aged 80+, the subgroup of older adults most at risk of needing long-term services and support. This study uses data from the CENSUS HUB database and from the UN database to calculate the current (last year available: 2011) and projected (2020, 2030, 2040 and 2050) CSR for a group of European countries. Mediterranean countries, France, Belgium, and Sweden presented the lowest CSR (5:1) in 2011. The countries with the highest CSR were Slovakia (9:1) and Ireland, Poland, Cyprus, and Malta (8:1). The estimated CSR is expected to progressively decline from 6:1 (2011) to 2:1 (2050) for all countries. Although differences in the CSR exist between countries, the number of people aged 45–64 who are available to care for each person aged 80+ will decrease uniformly in the coming decades. Cross-national challenges for gerontological social policies and healthcare provision are expected due to the increasing demand for long-term care among the oldest population.

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Kjellberg, Inger, et Stefan Szücs. « Pursuing collaborative advantage in Swedish care for older people : stakeholders' views on trust ». Journal of Integrated Care 28, n^o 3 (18 avril 2020) : 231–41. http://dx.doi.org/10.1108/jica-01-2020-0001.

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PurposeThe purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.Design/methodology/approachThe study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.FindingsThis study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.Research limitations/implicationsAlthough the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.Originality/valueSweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.

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Kavaliunas, Andrius, Virginija Danylaite Karrenbauer, Hanna Gyllensten, Ali Manouchehrinia, Anna Glaser, Tomas Olsson, Kristina Alexanderson et Jan Hillert. « Cognitive function is a major determinant of income among multiple sclerosis patients in Sweden acting independently from physical disability ». Multiple Sclerosis Journal 25, n^o 1 (16 novembre 2017) : 104–12. http://dx.doi.org/10.1177/1352458517740212.

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Background: In multiple sclerosis (MS), various aspects of cognitive function can be detrimentally affected, thus patients’ employment and social functioning is commonly impacted. Objective: To analyse income among MS patients in relation to cognitive function, assessed with the Symbol Digit Modalities Test (SDMT). Methods: A cross-sectional study including 2080 MS patients was conducted linking national register-based data. Descriptive statistics and a two-part model were used to estimate differences in earnings and social benefits. Results: MS patients in the highest SDMT score quartile earned more than twice annually compared to patients in the lowest quartile, whereas patients in the lowest quartile received three times more income through social benefits. The difference in earnings and benefits across the SDMT performance quartiles remained statistically significant after adjusting for various clinical and socio-demographic variables, including physical disability. The corrected prevalence ratios for MS patients in the highest quartile for having income from earnings and benefits were 1.40 (95% confidence interval (CI): 1.29–1.49) and 0.81 (95% CI: 0.71–0.90), respectively, when compared to the patients in the lowest quartile. Conclusion: Cognitive function affects the financial situation of MS patients negatively and independently of physical disability. This warrants cognitive testing as a routine measure in health care services for MS patients.

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Wollter, Filip, Ola Segnestam Larsson et Lars Oscarsson. « Sustaining a plurality of imperatives : an institutional analysis of knowledge perspectives in Swedish social service policies ». Social Work and Social Sciences Review 22, n^o 2 (8 avril 2021) : 23–44. http://dx.doi.org/10.1921/swssr.v22i2.1511.

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Social services are among the public policy areas criticized for lacking a reliable knowledge base to support professional as well as political ambitions and actions. This article contributes to the literature on knowledge perspectives in social service policies by studying and analyzing mechanisms that sustain a plurality of perspectives in the policies. The empirical material consists of knowledge perspectives in social service policies at the national level for child and family care and substance abuse treatment in Sweden between 1992 and 2015. Mechanisms that sustain a plurality of perspectives are identified with the support of an institutional logics framework. The main findings are that a plurality of knowledge perspectives. such as professional, scientific, and organizational, seems to be a permanent rather than temporary configuration; and that this permanent plurality is sustained by a set of mechanisms, including assimilation, blending, segregation, and contradiction. Despite this pluralism, there are few comments or guidelines in policy regarding the relationship between different knowledge perspectives. The findings suggest that more attention should be paid to the relationship between different knowledge perspectives and its impact on social work practice. In this, research and practice together need to support a development towards a more transparent professional acting.

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