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  • 1. Ahmed, Sayem
    et al.
    Hasan, Md. Zahid
    Laokri, Samia
    Jannat, Zerin
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Ahmed, Mohammad Wahid
    Dorin, Farzana
    Vargas, Veronica
    Khan, Jahangir A. M.
    Technical efficiency of public district hospitals in Bangladesh: a data envelopment analysis2019In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 17, article id 15Article in journal (Refereed)
    Abstract [en]

    Background: District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh. Methods: We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores. Results: The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output. Conclusion: Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.

  • 2.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Burström, Bo
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 290Article, review/survey (Refereed)
    Abstract [en]

    Background

    Herd immunity levels of vaccine uptake are still not reached in some high-income countries, usually in countries with persisting social inequities in uptake. Previous studies have focused on factors within one health care system. This study takes a broader health care systems approach by reviewing the socioeconomic distribution of vaccination coverage on the national level in light of structural and organizational differences of primary care for children.

    Methods

    A systematic literature review of socio-economic patterns of uptake of Measles-Mumps-Rubella (MMR) and/or Diphteria-Tetanus-Pertusis (DTP) in population based studies of children 0–5 years of age living in the 30 European Economic Area (EEA) or European Free Trade Association (EFTA) countries and Australia, was carried out using the PRISMA guidelines. The health care system in the countries in the study were categorized by degree of freedom of the primary care provider (hierarchical or non-hierarchical) and whether preventive services were provided in a separate organization (well-baby clinics).

    Results

    The review identified 15 studies from 10 European countries and Australia that fulfilled the criteria. Although the heterogeneity of the socio-economic indicators did not allow for a conclusive meta-analysis, the study pointed towards lower levels of inequities in primary care models with well-baby clinics. In non-hierarchical primary care organizations that also lacked well-baby clinics, socioeconomic gaps in uptake were often found to be large.

    Conclusion

    This review indicates that structural and organizational aspects of health care systems for young children are important for equity in vaccine uptake.

  • 3.
    Axelsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    HR-medarbetares upplevelser kring spelprevention och policyimplementering på arbetsplatsen2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The complex concept regarding harmful use of different nature, could be related to the use of alcohol, drugs or gambling. Such activities could affect the efficiency and productivity of an employee in a workplace environment in a negative way. At the request of the Public Health Agency of Sweden, a group of scientist was given the task to evaluate a project regarding education concerning problematic gambling. The purpose of the current study is to evaluate a project regarding education concerning gambling and gambling prevention, and was carried out by the organization Alna. Thematic analysis was used and collection of data was done with semi structured interviews, with ten HR-employees whose five organisations was included in the project Gambling and gambling preventive efforts directed towards the labour market. The results show that the methods and tools used by Alna is perceived as efficient and valuable by the participants. Some obstacles which works against efficient implementation of updated policies and guidelines were identified and these could consist of time constraints, under staffing or subordinated priority of the gambling issue per se. Furthermore it seems that the education project regarding gambling prevention performed by Alna has contributed to the development of policies and guidelines regarding harmful use of different kinds with focus on the gambling issue.  

  • 4. Barbosa, Cristina
    et al.
    Feio, Paulo
    Fernandes, Ana
    Thorslund, Mats
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    GOVERNANCE STRATEGIES TO AN AGEING SOCIETY - LOCAL ROLL IN MULTI LEVEL PROCESSES2016In: Journal of Comparative Politics, ISSN 1337-7477, E-ISSN 1338-1385, Vol. 9, no 1, p. 4-18Article in journal (Refereed)
    Abstract [en]

    Demographic ageing marks strategic orientations and public policies. It's a challenge to societies, public and private institutions and Welfare State. The goal of this study is to understand the local governance strategies to an ageing population and the role of the local in multilevel governance processes. A qualitative methodology it was followed that supports analysis and understanding of both local ageing policies. The samples are case studies of two contexts, Portugal and Sweden, respectively city councils of Lisbon and Nacka, where stakeholders were interviewed. Different concepts and visions influence local ageing policies. Vertical coordination is easier to follow in Portugal, but without concrete laws, and in Sweden, horizontal coordination is emphasized between providers and municipalities. Local public intervention in ageing seeks renewed actions and this study allows to conclude that a perfect local policy doesn't exist. However in many aspects, can be complementary.

  • 5. Beaussant, Yvan
    et al.
    Daguindau, Etienne
    Chauchet, Adrien
    Rochigneux, Philippe
    Tournigand, Christophe
    Aubry, Régis
    Morin, Lucas
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hospital end-of-life care in haematological malignancies2018In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 8, no 3, p. 314-324Article in journal (Refereed)
    Abstract [en]

    Objective To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies.

    Methods Nationwide register-based study, including all hospitalised adults >= 20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation.

    Results Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin's lymphoma (P<0.001). Invasive ventilation was used in 10.2% of patients with acute leukaemia but in 19.0% of patients with Hodgkin's lymphoma (P<0.001). Palliative status was reported 30 days before death in only 14.8% of patients, and at time of death in 46.9% of cases. Overall, 5.5% of haematology patients died in palliative care units.

    Conclusion A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies.

  • 6. Broda, Anja
    et al.
    Bieber, Anja
    Meyer, Gabriele
    Hopper, Louise
    Joyce, Rachael
    Irving, Kate
    Zanetti, Orazio
    Portolani, Elisa
    Kerpershoek, Liselot
    Verhey, Frans
    de Vugt, Marjolein
    Wolfs, Claire
    Eriksen, Siren
    Rosvik, Janne
    Marques, Maria J.
    Goncalves-Pereira, Manuel
    Sjölund, Britt-Marie
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Gävle, Sweden.
    Woods, Bob
    Jelley, Hannah
    Orrell, Martin
    Stephan, Astrid
    Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 518Article in journal (Refereed)
    Abstract [en]

    Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics Complexity and Continuity of Care, Formal Services, and Public Awareness. Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

  • 7.
    Brodin, Jane
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Stancheva-Popkostadinova, Vaska
    Faculty of Public Health and Sport, South-West University, Neofit Rilski, Blagoevgrad.
    Early Interventions in Children with Intellectual Disabilities2009In: Annals of Union of Scientists: Science, Culture and Education, Blagoevgrad, Bulgaria: Annual of Union of Scientiests , 2009, p. 215-220Chapter in book (Other academic)
    Abstract [en]

    Support services required by families with children with intellectual disabilities vary in different countries and depend mainly on the social environment in each society. This is essential to recognize when intervention is conducted with children with disabilities and their families. Early intervention was previously and is still partly connected to the theory of sensitive periods in early child development altthough the view of child development and childhood has nowadays been changed.The article focuses on early intervention in children  primarily with intellectual disabilities.

  • 8.
    Brodin, Jane
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    Stancheva-Popkostadinova, Vaska
    South-West University, Blagoevgrad, Bulgaria.
    Intervention of communication in children with intellectual disabilities2009In: Scientific Research - Juridical, economical and social science, ISSN 1312-7535, Vol. 7, p. 1-10Article in journal (Refereed)
    Abstract [en]

    The article is a result of a longitudinal cooperation between  Sweden and Bulgaria in the framework of Erasmus teacher exchange program in education and research.

  • 9. Choi, Soki
    et al.
    Holmberg, Ingalill
    Löwstedt, Jan
    Stockholm University, Faculty of Social Sciences, Stockholm Business School, Management & Organisation.
    Brommels, Mats
    Managing clinical integration: a comparative study in a merged university hospital2012In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 26, no 4, p. 486-507Article in journal (Refereed)
    Abstract [en]

    Purpose - This paper explores critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase our understanding of why clinical integration succeeds or fails.

    Design/methodology/approach - We compare two cases of integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged departments of the same specialty from each hospital site. We conducted 53 interviews with individuals representing various staff categories and collected documents to check data consistency.

    Findings - The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts – clinical management’s 1) interpretation of the mandate, 2) design of the management constellation and 3) approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top-down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom-up management approach within planned boundaries. These findings are basically consistent with the literature’s prescriptions for managing professional organisations.

    Practical implications - Managers need to understand that public healthcare organisations are based on multiple logics that need to be handled in a balanced way if clinical integration is to be achieved – especially the tension between managerialism and professionalism.

    Originality/value - By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

  • 10. Dams, Judith
    et al.
    Buchholz, Angela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institute for Therapeutic Research Munich, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Scherbaum, Norbert
    Konnopka, Alexander
    König, Hans-Helmut
    Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e020563Article in journal (Refereed)
    Abstract [en]

    Objectives Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. Design In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. Settings Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). Participants n=236adult patients with alcohol dependence and n=4687adult individuals without alcohol dependence. Primary and secondary outcome measures The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. Results Total 6-month excess costs of Euro11839 (95% CI Euro11 529 to Euro12 147) were caused by direct excess costs of Euro4349 (95% CI Euro4129 to Euro4566) and indirect costs of Euro7490 (95% CI Euro5124 to Euro9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. Conclusions Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. Trial registration number DRKS00005035.

  • 11. Ekström, Andreas
    et al.
    Eng Larsson, Fredrik
    Stockholm University, Faculty of Social Sciences, Stockholm Business School.
    Isaksson, Olov
    Stockholm University, Faculty of Social Sciences, Stockholm Business School.
    Kurland, Lisa
    Nordberg, Martin
    The effect of a terrorist attack on emergency department inflow: an observation study using difference-in-differences methodology2019In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, article id 57Article in journal (Refereed)
    Abstract [en]

    Study objectiveThe objective of this study was to investigate how the terrorist attack in Stockholm, Sweden affected patient inflow to the general emergency departments (EDs) in close proximity of the attack. The study analyzed if, and to what extent, the attack impacted ED inflow during the following days and weeks.MethodsIn a retrospective observational study, anonymized aggregated data on ED arrivals (inflow of patients) to all seven of the EDs in the Stockholm County was analyzed using the Difference-in-Differences (DiD) estimator. The control groups were the affected hospitals in the years prior to the terrorist attack. The number of ED visits was retrieved from the Stockholm County Council administrative database.ResultsThe study shows a statistically significant reduction in overall ED inflow of 7-9% following the attack. The effect was strongest initially after the attack, and ED inflow regained normal levels within approximately three weeks' time, without any significant rebound effect. The effect on ED inflow also decreased with distance from ground zero, and was not significant further away than 10km.ConclusionThe results showed that ED inflow was significantly decreased in the weeks immediately following the Stockholm terrorist attack. The reasons for this cannot be fully explained in this observational study. However, the results suggest that some patients actively choose when, where and if they should go to the ED.

  • 12.
    Falkenström, Erica
    et al.
    Stockholm University, Faculty of Social Sciences, Stockholm Centre for Organizational Research (SCORE).
    Höglund, Anna T.
    På spaning efter etik: Etisk kompetens och ansvarstagande för ledning och styrning av hälso- och sjukvården2018Book (Other academic)
    Abstract [sv]

    Kraven på vårdens professioner och chefer är höga. De förväntas ge en god och säker vård på lika villkor till hela befolkningen, administrera, prioritera och arbeta kostnadseffektivt. Men hälso- och sjukvården fungerar inte som den ska. Arbetsmiljön är osund, sjuksköterskor lämnar yrket, vården är ojämlik och svårt sjuka patienter får vänta i långa köer. Detta gör att människors liv, hälsa och värdighet står på spel.

    På spaning efter etik uppmärksammar tre nyckelgrupper av aktörer som genom sina beslut har ett stort inflytande över vårdens villkor: politiker, opolitiska chefstjänstemän och vårdgivarnas högsta chefer i landstingets ledningsorganisation. Hur ser de på sitt etiska ansvar för hälso- och sjukvården? Vilka etiska bedömningar och konsekvensanalyser gör de? Och vilken etisk kompetens fordras för att de ska kunna ta ett etiskt ansvar för vårdens villkor genom ledning, styrning och organisation på den regionala nivån – och därmed för att samhällsmedborgarna ska kunna känna tillit till att vården fungerar som den ska?

    Boken är ett resultat av ett tvärvetenskapligt empirisk forskningsprojekt, finansierat av AFA Försäkring, som har bedrivits på Stockholms centrum för forskning om offentlig sektor, Score.

  • 13.
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nationell utvärdering – vård och omsorg vid demenssjukdom 2014: indikatorer och underlag för bedömningar2014Report (Other academic)
  • 14. Forslid, Rikard
    et al.
    Herzing, Mathias
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    ON THE OPTIMAL PRODUCTION CAPACITY FOR INFLUENZA VACCINE2015In: Health Economics, ISSN 1057-9230, E-ISSN 1099-1050, Vol. 24, no 6, p. 726-741Article in journal (Refereed)
    Abstract [en]

    This paper analyzes the profit maximizing capacity choice of a monopolistic vaccine producer facing the uncertain event of a pandemic in a homogenous population of forward-looking individuals. For any capacity level, the monopolist solves the intertemporal price discrimination problem within the dynamic setting generated by the standard mathematical epidemiological model of infectious diseases. Even though consumers are assumed to be identical, the monopolist will be able to exploit the ex post heterogeneity between infected and susceptible individuals by raising the price of vaccine in response to the increasing hazard rate. The monopolist thus bases its investment decision on the expected profits from the optimal price path given the infection dynamics. It is shown that the monopolist will always choose to invest in a lower production capacity than the social planner. Through numerical simulation, it is demonstrated how the loss to society of having a monopoly producer decreases with the speed of infection transmission. Moreover, it is illustrated how the monopolist's optimal vaccination rate increases as its discount rate rises for cost parameters based on Swedish data. However, the effect of the firm discount rate on its investment decision is sensitive to assumptions regarding the cost of production capacity.

  • 15. Granhagen Jungner, Johanna
    et al.
    Tiselius, Elisabet
    Stockholm University, Faculty of Humanities, Department of Swedish Language and Multilingualism. Karolinska Institutet, Sweden.
    Blomgren, Klas
    Lützén, Kim
    Pergert, Pernilla
    Language barriers and the use of professional interpreters: a national multisite cross-sectional survey in pediatric oncology care2019In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226XArticle in journal (Refereed)
    Abstract [en]

    Background: Healthcare personnel are responsible for providing patient-centered care regardless of their patients' language skills, but language barriers is identified as the main hindrances providing effective, equitable and safe care to patients with limited proficiency in a country's majority language. This study is a national multisite cross-sectional survey aiming to investigate communication over language barriers in pediatric oncology care. Material and Methods: A survey using the Communication over Language Barriers questionnaire (CoLB-q) distributed to medical doctors, registered nurses and nursing assistants at six pediatric oncology centers in Sweden (response rate 90%) using descriptive statistical analyses. Results: Professional interpreters on site were the most common solution when using an interpreter, although relatives or even children were used. The use of professional interpreters on site differed among the professions and in different clinical situations, such as medical encounter, education or procedure preparation. All professions reported that the use of professional interpreters greatly increased care relationships, patient safety and patient involvement in care. Conclusions: Healthcare personnel seem to believe that professional interpreters are crucial when caring for patients and family members who do not speak the majority language, but there is an obvious discrepancy between this belief and their use of professional interpreters.

  • 16.
    Granqvist, Roland
    Stockholm University.
    Studier i sjukvårdsekonomi1978Doctoral thesis, monograph (Other academic)
  • 17. Gärtner, Manja
    et al.
    Sandberg, Anna
    Stockholm University, Faculty of Social Sciences, Institute for International Economic Studies.
    Is there an omission effect in prosocial behavior? A laboratory experiment on passive vs. active generosity2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, article id e0172496Article in journal (Refereed)
    Abstract [en]

    We investigate whether individuals are more prone to act selfishly if they can passively allow for an outcome to be implemented (omission) rather than having to make an active choice (commission). In most settings, active and passive choice alternatives differ in terms of factors such as the presence of a suggested option, costs of taking an action, and awareness. We isolate the omission effect from confounding factors in three experiments, and find no evidence that the distinction between active and passive choices has an independent effect on the propensity to implement selfish outcomes. This suggests that increased selfishness through omission, as observed in various economic choice situations, is driven by other factors than a preference for selfish omissions.

  • 18.
    Hassanen, Sadia
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Anthropology.
    Woldu, Dawit Okubatsion
    Mkuu, Rahma
    The effects of migration on the practice and perception Female Genital Cutting (FGC) among the Horn of Africa's immigrants in Melbourne Australia2019In: AIMS public health, ISSN 2327-8994, Vol. 6, no 1, p. 67-78Article in journal (Refereed)
    Abstract [en]

    This research examines the effects of migration on the practice and perception of Female Genital Mutilation or Cutting (FGM/C) among Horn of Africa immigrants in Melbourne Australia. According to UN 2016 report, on (FGM/C), there are at least 200 million girls and women alive today globally that have undergone some of form of FGM/C. The same report highlights that most of these practices are concentrated in parts of Africa, Middle East and South Asia. Our research employed in-depth semi-structured interviews with 50 men and women informants and five focus groups among the Horn of Africa immigrants living in Melbourne Australia. Interview and focus group data were analysed using MAXQUDA text analysis software to see emerging themes from the data. Upon the examination of the interviews and focus group data, we found that gender and immigration were the two factors that influenced immigrant's perception about FGC. Understanding the social and cultural dynamics on the perception of FGC among immigrant communities in the West could help in devising appropriate interventions to tackle FGC in several groups where this practice is commonly occurring.

  • 19. Hasselbladh, Hans
    et al.
    Bejerot, Eva
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Performative policy: the case of Swedish healthcare reforms2017In: Critical Policy Studies, ISSN 1946-0171, E-ISSN 1946-018X, Vol. 11, no 3, p. 291-310Article in journal (Refereed)
    Abstract [en]

    In this article we analyze public sector change as a profoundly constructed phenomenon - as performative reforms. Public sector reforms, of which policy processes are an integral part, are constituted and realized through long chains of interventions. Communicative-discursive interventions posit and constitute problems as real and important, while technocratic interventions, such as plans, analyses, and schemes construct new imagined worlds for possible and attractive instrumental solutions. Our empirical results display circular movements of three modes of change, making up a continuous policy cycle in the transformation of Swedish health, reiterated on different levels of the system, in different scales, and with different actors involved. The continuity of the reforms is to a large extent the result of a successful institutionalization of the policy cycle and its content. It is stabilized as a set of discourse and social technologies, distributed throughout the entire healthcare system and almost impossible to question.

  • 20.
    Hasson, Dan
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Gustavsson, Petter
    Trends in self-rated health among nurses: a 4-year longitudinal study on the transition from nursing education to working life2010In: Journal of Professional Nursing, ISSN 8755-7223, E-ISSN 1532-8481, Vol. 26, no 1, p. 54-60Article in journal (Refereed)
    Abstract [en]

    For nurses, the transition from higher education to working life involves several types of changes and seems to be a major contributing cause of distress and, consequently, ill health on a longer term basis. The aim of this study was to longitudinally monitor the development of self-rated health (SRH) in nurses, starting from the last semester at the university with subsequent follow-ups when the nurses had entered working life. The Longitudinal Analyses of Nurses' Education and working life is an ongoing nationwide longitudinal project focusing on mapping health and career development in nurses in Sweden. SRH is one of the most widely used single-item measures of perceived health status with a well-established predictive ability on future health outcomes, including morbidity and mortality. This study found a small but significant and continuous decline in SRH among nurses during 3 years of follow-ups, starting from their last semester of nursing education and continuing 3 years into their working life. The most pronounced decline in SRH seems to occur in the transition between student life and working life and is most explicit among the youngest nurses. However, the long-term effect on SRH when entering into working life seems to be more pronounced among the older nurses.

  • 21. Hedman, Erik
    et al.
    Andersson, Erik
    Ljótsson, Brjánn
    Axelsson, Erland
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden .
    Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 4, article id e009327Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Internet-delivered exposure-based cognitive behaviour therapy (ICBT) has been shown to be effective in the treatment of severe health anxiety. The health economic effects of the treatment have, however, been insufficiently studied and no prior study has investigated the effect of ICBT compared with an active psychological treatment. The aim of the present study was to investigate the cost effectiveness of ICBT compared with internet-delivered behavioural stress management (IBSM) for adults with severe health anxiety defined as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. ICBT was hypothesised to be the more cost-effective treatment.

    SETTING: This was a cost-effectiveness study within the context of a randomised controlled trial conducted in a primary care/university setting. Participants from all of Sweden could apply to participate.

    PARTICIPANTS: Self-referred adults (N=158) with a principal diagnosis of DSM-IV hypochondriasis, of whom 151 (96%) provided baseline and post-treatment data.

    INTERVENTIONS: ICBT or IBSM for 12 weeks.

    PRIMARY AND SECONDARY MEASURES: The primary outcome was the Health Anxiety Inventory. The secondary outcome was the EQ-5D. Other secondary measures were used in the main outcome study but were not relevant for the present health economic analysis.

    RESULTS: Both treatments led to significant reductions in gross total costs, costs of healthcare visits, direct non-medical costs and costs of domestic work cutback (p=0.000-0.035). The incremental cost-effectiveness ratio (ICER) indicated that the cost of one additional case of clinically significant improvement in ICBT compared with IBSM was $2214. The cost-utility ICER, that is, the cost of one additional quality-adjusted life year, was estimated to be $10 000.

    CONCLUSIONS: ICBT is a cost-effective treatment compared with IBSM and treatment costs are offset by societal net cost reductions in a short time. A cost-benefit analysis speaks for ICBT to play an important role in increasing access to effective treatment for severe health anxiety.

    TRIAL REGISTRATION NUMBER: NCT01673035; Results.

  • 22.
    Hernández-Neuta, Iván
    et al.
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Neumann, Felix
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Brightmeyer, J.
    Tis, T. Ba
    Madaboosi, Narayanan
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Wei, Q.
    Ozcan, A.
    Nilsson, Mats
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Smartphone-based clinical diagnostics: towards democratization of evidence-based health care2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 1, p. 19-39Article, review/survey (Refereed)
    Abstract [en]

    Recent advancements in bioanalytical techniques have led to the development of novel and robust diagnostic approaches that hold promise for providing optimal patient treatment, guiding prevention programs and widening the scope of personalized medicine. However, these advanced diagnostic techniques are still complex, expensive and limited to centralized healthcare facilities or research laboratories. This significantly hinders the use of evidence-based diagnostics for resource-limited settings and the primary care, thus creating a gap between healthcare providers and patients, leaving these populations without access to precision and quality medicine. Smartphone-based imaging and sensing platforms are emerging as promising alternatives for bridging this gap and decentralizing diagnostic tests offering practical features such as portability, cost-effectiveness and connectivity. Moreover, towards simplifying and automating bioanalytical techniques, biosensors and lab-on-a-chip technologies have become essential to interface and integrate these assays, bringing together the high precision and sensitivity of diagnostic techniques with the connectivity and computational power of smartphones. Here, we provide an overview of the emerging field of clinical smartphone diagnostics and its contributing technologies, as well as their wide range of areas of application, which span from haematology to digital pathology and rapid infectious disease diagnostics.

  • 23.
    Herrgård, Moa M.
    et al.
    Stockholm University, Faculty of Law, Department of Law. Lund University, Sweden; United Nations Major Group for Children and Youth, United Kingdom.
    Rabe, Adrian Paul J.
    Lo, Sharon
    Ragazzoni, Luca
    Burkle, Frederick M.
    Building resilience by professionalization of healthcare workers through technological innovations2017In: International Journal of Disaster Risk Reduction, E-ISSN 2212-4209, Vol. 22, p. 246-248Article, review/survey (Refereed)
    Abstract [en]

    Disaster medicine remains an underdeveloped specialty field requiring significant focus [6,12]. This paper recommends that professionalization of this specialty is a global health priority, benchmarking it according to emerging global health standards. This paper emphasis the importance of technological innovations and increased access to the internet, to ensure enhanced learning and a greater reach of essential information. Education and training initiatives in disaster medicine are emerging with greater frequency leading to a call for unified standards of practice and policy necessary to build the capacity of future health worker and other to be effective responders to humanitarian and disaster crises. These initiatives will contribute to increased resilience, and more robust and sustainable development at the community level contributing greatly to disaster risk reduction and management.

  • 24. Hiswåls, Anne-Sofie
    et al.
    Ghilagaber, Gebrenegus
    Stockholm University, Faculty of Social Sciences, Department of Statistics.
    Wijk, Katarina
    Öberg, Peter
    Soares, Joaquim
    Macassa, Gloria
    Employment Status and Suicidal Ideation during Economic Recession2015In: Health science journal, ISSN 1791-809X, Vol. 9, no 1, p. 1-9, article id 13Article in journal (Refereed)
    Abstract [en]

     

    Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County.

    Method:

    The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation

    Results:

    Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation.

    Conclusion:

    There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

  • 25.
    Hjern, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Stubbe Østergaard, Liv
    Norredam, Marie
    Mock-Muñoz de Luna, Claire
    Goldfeld, Sharon
    Health policies for migrant children in Europe and Australia2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10066, p. 249-249Article in journal (Refereed)
  • 26.
    Håkansson, Stefan
    Stockholm University.
    Kostnadsvariationer inom sjukvården: jämförande studier på landstings- och kliniknivå1980Doctoral thesis, monograph (Other academic)
  • 27. Höglund, Anna T.
    et al.
    Falkenström, Erica
    Stockholm University, Faculty of Social Sciences, Stockholm Centre for Organizational Research (SCORE).
    The status of ethics in Swedish health care management: a qualitative study2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 608Article in journal (Refereed)
    Abstract [en]

    Background: By tradition, the Swedish health care system is based on a representative and parliamentary form of government. Recently, new management forms, inspired by market principles, have developed. The steering system is both national and regional, in that self-governing county councils are responsible for the financing and provision of health care in different regions. National and local documents regulating Swedish health care mention several ethical values, such as equity in health for the whole population and respect for autonomy and human dignity. It is therefore of interest to investigate the status of such ethical statements in Swedish health care management. Method: The aim of the present study was to investigate perceptions of the status of ethics in the daily work of politicians, chief civil servants and Chief Executive Officers (CEOs) from care-giver organizations in the county council of Stockholm. A qualitative method was used, based on inductive content analysis of individual interviews with 13 health care managers. Results: The content analysis resulted in four categories: Low status of ethics; Cost-effectiveness over ethics; Separation of ethics from management; and Lack of opportunities for ethical competence building. The informants described how they prioritized economic concerns over ethics and separated ethics from their daily work. They also expressed that they experienced that this development had been enforced by the marketization of the health care system. Further, they described how they lacked opportunities for ethical discussions, which could have helped develop their ethical competence. Conclusions: In order to improve the status of ethics in health care management, ethical considerations and analyses must be integrated in the regular work tasks of politicians, chief civil servants and CEOs; such as decision-making, budgeting and reform work. Further, opportunities for ethical dialogues on a regular basis should be organized, in order to improve ethical competence on the management level. New steering forms, less focused upon market principles, might also be needed, in order to improve the status of ethics in the health care management organization.

  • 28. Hörberg, Anna
    et al.
    Lindström, Veronica
    Kalén, Susanne
    Scheja, Max
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Vicente, Veronica
    Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden2017In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 27, p. 63-70Article in journal (Refereed)
    Abstract [en]

    New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, Striving for balance during the transition process in the ambulance context. Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development.

  • 29.
    Johansson, Lennarth
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Long, Helen
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Parker, Marti G.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Informal Caregiving for Elders in Sweden: An Analysis of Current Policy Developments2011In: Journal of Aging & Social Policy, ISSN 0895-9420, E-ISSN 1545-0821, Vol. 23, no 4, p. 335-53Article in journal (Refereed)
    Abstract [en]

    In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was “rediscovered” regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the “Swedish model” of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing “caregivers movement” is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: “Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities.” The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.

  • 30. Johansson-Pajala, Rose-Marie
    et al.
    Jorsäter Blomgren, Kerstin
    Bastholm-Rahmner, Pia
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Martin, Lene
    Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Objective: To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as vigilant intermediaries in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as vigilant intermediaries in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities.

  • 31. Joling, Karlijn J.
    et al.
    van Eenoo, Liza
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Universita`Cattolica Sacro Cuore, Italy.
    Smaardijk, Veerle R.
    Declercq, Anja
    Onder, Graziano
    van Hout, Hein P. J.
    van der Roest, Henriette G.
    Quality indicators for community care for older people: A systematic review2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190298Article, review/survey (Refereed)
    Abstract [en]

    Background

    Health care systems that succeed in preventing long term care and hospital admissions of frail older people may substantially save on their public spending. The key might be found in high-quality care in the community. Quality Indicators (QIs) of a sufficient methodological level are a prerequisite to monitor, compare, and improve care quality. This systematic review identified existing QIs for community care for older people and assessed their methodological quality.

    Methods

    Relevant studies were identified by searches in electronic reference databases and selected by two reviewers independently. Eligible publications described the development or application of QIs to assess the quality of community care for older people. Information about the QIs, the study sample, and specific setting was extracted. The methodological quality of the QI sets was assessed with the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. A score of 50% or higher on a domain was considered to indicate high methodological quality.

    Results

    Searches resulted in 25 included articles, describing 17 QI sets with 567 QIs. Most indicators referred to care processes (80%) and measured clinical issues (63%), mainly about follow-up, monitoring, examinations and treatment. About two-third of the QIs focussed on specific disease groups. The methodological quality of the indicator sets varied considerably. The highest overall level was achieved on the domain 'Additional evidence, formulation and usage' (51%), followed by 'Scientific evidence' (39%) and 'Stakeholder involvement' (28%).

    Conclusion

    A substantial number of QIs is available to assess the quality of community care for older people. However, generic QIs, measuring care outcomes and non-clinical aspects are relatively scarce and most QI sets do not meet standards of high methodological quality. This study can support policy makers and clinicians to navigate through a large number of QIs and select QIs for their purposes.

  • 32.
    Krystek, Sofia
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Upplevelser av sjukskrivningsprocessen ur olika perspektiv2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sjukfrånvaro är ett komplext fenomen som påverkas av olika faktorer på olika nivåer, från individer till samhällen. Fortfarande saknas det dock studier av hur de olika aktörerna som deltar i en sjukskrivningsprocess upplever processen. Syftet med denna intervjustudie var att undersöka hur fyra olika aktörer, Försäkringskassan, företagshälsovården, arbetsgivaren och den sjukskrivne upplever varandra och sjukskrivningsprocessen. Totalt deltog sex personer i halvstrukturerade intervjuer som sedan bearbetades enligt tematisk analys. Resultatet visar att de olika aktörerna har olika perspektiv och i vissa fall har svårt att förstå varandras roller i sjukskrivingsprocessen. Vidare framkommer det att många problem tycks bero på att det saknas en effektiv samordnande funktion av sjukskrivningsprocessen, vilket har negativa konsekvenser för hela processen och även påverkar samarbetet mellan de olika aktörerna. Slutsatsen blir att många problem skulle kunna lösas genom effektivare samordning i sjukskrivningsprocessen.

  • 33.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Chungkham, Holendro Singh
    Indian Statistical Institute, North-East Centre, India.
    Lindqvist, Rikard
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Runnesdotter, Sara
    Smeds Alenius, Lisa
    Tishelman, Carol
    Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study2016In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 58, p. 47-58Article in journal (Refereed)
    Abstract [en]

    Background

    Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.

    Objective

    The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.

    Design

    Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.

    Results

    Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.

    Conclusions

    We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.

  • 34.
    Lärka Paulin, Sanja
    et al.
    Stockholm University, The Stockholm Institute of Education.
    Bernehäll Claesson, Inger
    Stockholm University, The Stockholm Institute of Education.
    Brodin, Jane
    Stockholm University, The Stockholm Institute of Education.
    Familjer med barn med muskelsjukdomar: Inflytande och medverkan i beslutsprocessen2000Report (Other academic)
    Abstract [sv]

    Många familjer med barn med funktionsnedsättningar har stora svårigheter i sitt vardagsliv och speciellt gäller detta familjernas möjligheter att få stöd. Samhället har enligt lag skyldighet att tillhandahålla olika former av stöd, men det tycks inte alltid somom det stöd som erbjuds svarar mot familjens behov.

  • 35.
    Montell, Camilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Butiksrån: Upplevelser, bearbetning och behov av stöd2006Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Antalet väpnade butiksrån ökar. Denna examensuppsats syftar till att försöka förstå drabbades upplevelse, samt att undersöka hur ”hjälpare” kan stödja drabbade. Studiens upplägg, inspirerat av Grundad Teori, antar ett fenomenologiskt perspektiv. Studien är en del av projektet ”Traumatisk Stress i Arbetslivet”. Telefonintervjuer genomfördes med drabbade av butiksrån. Informanternas berättelser tydliggör butiksrånets karaktär av traumatisk upplevelse. Ungefär hälften av informanterna uppgav att de fått visst krisstöd, medan andra inte fått något stöd alls. De flesta menade dock att de återhämtat sig efter rånet, men kvarstående förändringar kan ses bl.a. i försämrad grundtrygghet. En litteraturgenomgång visar att traumapsykologi är ett nytt forskningsområde. För att bedöma individens risk för posttraumatiska besvär rekommenderas stress-sårbarhetsmodellen. Skyddande faktorer som diskuteras är socialt stöd och känsla av sammanhang tillsammans med akuta interventioner och psykoterapeutisk behandling.

  • 36.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Aubry, Régis
    Palliative care in hospital-at-home services in France / Soins palliatifs en hospitalisation à domicile: A nationwide study using administrative data / état des lieux à partir des données hospitalières2017In: Médecine palliative, ISSN 1636-6522, Vol. 16, no 1, p. 7-20Article in journal (Refereed)
    Abstract [en]

    Background

    Hospital-at-home services have a key role in providing palliative care to people with complex needs at home. This study aimed to examine and describe the development of palliative care in hospital-at-home services between 2008 and 2014 in France.

    Methods

    Aggregated data were extracted from the national hospital registry (PMSI) to describe the delivery of palliative care by hospital-at-home services and to measure variation over time and across geographical areas.

    Results

    Hospital-at-home services increased the provision of palliative care between 2008 and 2014 (+61 % increase in the number of home-based hospitalizations, accounting for 28,000 patients in 2014). Palliative care now accounts for 23.6 % of the total number of days of hospitalization. During the same period, the mean age of patients and their level of activity of daily living impairment increased. Cancer remains the most frequent diagnosis: the 30 most common tumor localizations are found in nearly 60 % of the total case-mix. In 2014, almost 18,000 individuals died while being hospitalized at home (including 13,700 during a palliative care stay), the proportion of deaths in overall number of discharges rising from 7.2 % in 2008 to 10.2 % in 2014. However, we found considerable variation in the development of palliative care in hospital-at-home services across counties (from 0.5 to 87.5 palliative care home-based hospitalization per 1000 deaths).

    Conclusion

    The provision of palliative care by hospital-at-home services remains insufficient compared with the needs for home-based palliative care in the general population. It is therefore necessary to significantly increase the number of beneficiaries, while ensuring high-quality palliative care.

  • 37.
    Morin, Lucas
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Wastesson, Jonas W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Laroche, Marie-Laure
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johnell, Kristina
    How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study2019In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 33, no 8, p. 1080-1090Article in journal (Refereed)
    Abstract [en]

    Background: The high burden of disease-oriented drugs among older adults with limited life expectancy raises important questions about the potential futility of care.

    Aim: To describe the use of drugs of questionable clinical benefit during the last 3 months of life of older adults who died from life-limiting conditions.

    Design: Longitudinal, retrospective cohort study of decedents. Death certificate data were linked to administrative and healthcare registries with national coverage in Sweden.

    Setting: Older adults (>= 75 years) who died from conditions potentially amenable to palliative care between 1 January and 31 December 2015 in Sweden. We identified drugs of questionable clinical benefit from a set of consensus-based criteria.

    Results: A total of 58,415 decedents were included (mean age, 87.0 years). During their last 3 months of life, they received on average 8.9 different drugs. Overall, 32.0% of older adults continued and 14.0% initiated at least one drug of questionable clinical benefit (e.g. statins, calcium supplements, vitamin D, bisphosphonates, antidementia drugs). These proportions were highest among younger individuals (i.e. aged 75-84 years), among people who died from organ failure and among those with a large number of coexisting chronic conditions. Excluding people who died from acute and potentially unpredictable fatal events had little influence on the results.

    Conclusion: A substantial share of older persons with life-limiting diseases receive drugs of questionable clinical benefit during their last months of life. Adequate training, guidance and resources are needed to rationalize and deprescribe drug treatments for older adults near the end of life.

  • 38. Muth, C.
    et al.
    Blom, J. W.
    Smith, S. M.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Gonzalez-Gonzalez, A. I.
    Nguyen, T. S.
    Brueckle, M. -S.
    Cesari, M.
    Tinetti, M. E.
    Valderas, J. M.
    Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 3, p. 272-288Article, review/survey (Refereed)
    Abstract [en]

    The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.

  • 39. Nordenvall, Richard
    et al.
    Marcano, Alejandro I.
    Adami, Johanna
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Mattila, Ville M.
    Bahmanyar, Shahram
    Felländer-Tsai, Li
    The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 3, p. 535-540Article in journal (Refereed)
    Abstract [en]

    Background:

    The socioeconomic status (SES) of patients has been widely recognized as playing an important role in many health-related conditions, including orthopaedic conditions, in which a higher SES has been associated with a higher utilization of more advanced medical treatments such as drugs, diagnostics, and surgery. However, the association between SES and cruciate ligament surgery has not been thoroughly investigated.

    Purpose:

    To evaluate the association between SES and choice of treatment in patients with a cruciate ligament injury.

    Study Design:

    Cohort study; Level of evidence, 3.

    Methods:

    All Swedish patients with a diagnosed cruciate ligament injury between 1987 and 2010 were identified from the Swedish National Patient Register (N = 98,349). The Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA) provided information on household income and highest achieved educational level, which were used as socioeconomic indices. The exposure was the SES of patients as determined by the household income and educational level, and the main outcome measure was treatment choice (surgical reconstruction vs nonoperative treatment). Poisson regression models estimated the association.

    Results:

    A total of 52,566 patients were included in the study; of these, 20,660 (39%) were treated operatively. Patients in the highest quartile of household income had a significantly higher likelihood of undergoing surgery than those in the lowest quartile (relative risk [RR], 1.16; 95% CI, 1.11-1.20). Patients classified as highly educated had a significantly increased likelihood of being treated operatively compared with those with a low education (RR, 1.29; 95% CI, 1.19-1.39).

    Conclusion:

    This study provides a population-based validation that having a higher SES as determined by the household income and/or level of education increases the likelihood of undergoing operative treatment after a cruciate ligament injury.

    Clinical Relevance:

    All Swedish citizens are entitled by law to the same quality of health care; therefore, unmotivated differences in treatment between different socioeconomic groups are to be seen as a challenge. It is important to evaluate the specific mechanisms by which the patient's SES influences the decision of whether to treat a cruciate ligament injury operatively.

  • 40.
    Nycander, Gösta
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Family planning in the field: observations on fieldmidwives' workingbehaviour and analysis of factors affecting the quality and outcome of the Ceylonese programme1972Doctoral thesis, monograph (Other academic)
  • 41.
    Olsson, Ulf
    Stockholm University, Faculty of Science, Department of Education in Arts and Professions. Yrkeskunnande och lärande.
    OM FRISKVÅRDSPEDAGOGIK I ARBETSLIVET.: EN O/RÄTTVIS BETRAKTELSE.1993Licentiate thesis, monograph (Other academic)
    Abstract [sv]

    I fokus för detta arbete står friskvård inom arbetslivet som pedagogisk praktik med hälsoprofilsbedömning, en metod för undersökning och påverkan av människors hälsostatus och hälsovanor, som konkret exempel. En bakgrund till detta är framväxten av insatser för folkhälsa och den ökade betoning av friskvård inom arbetslivet som skett inom såväl privat som offentlig sektor. Friskvård handlar om människors levnadsvanor när det gäller kost, motion, stress, alkohol, tobak m.m.

    Hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet ses här ur två olika perspektiv. Ur det ena perspektivet behandlas verksamheten på dess egna villkor - som en metod att inom ramen för arbetslivet få till stånd ner hälsosamma livsstilar genom kontrakt mellan självständiga parter. Det andra perspektivet kan ses som kritiskt granskande. Här ifrågasätts premissema för hälsoprofilsbedömningen utifrån begrepp som makt och disciplinering. En inspirationskälla har därvid bland annat Michel Foucaults arbeten varit. Som empiriskt material för analysen används två avhandlingar som presenterar hälsoprofilbedömningen som metod.

    Ur dessa båda perspektiv erhålles två olika betraktelser om hälsoprofilsbedömning och friskvårdspedagogik inom arbetslivet - en rättvis och en orättvis. På basis av en kritisk pragmatisk ansats diskuteras möjligheten till ett samtal baserad på relationen mellan de båda betrakelserna.

  • 42. Rajmil, Luis
    et al.
    Taylor-Robinson, David
    Gunnlaugsson, Geir
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Spencer, Nick
    Trends in social determinants of child health and perinatal outcomes in European countries 2005-2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e022932Article in journal (Refereed)
    Abstract [en]

    Objective To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children's health (SDCH) in rich countries Design Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015. Setting and participants 16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat. Main outcome measures Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005-2007, 2008-2010 and 2012-2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods. Results Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012-2015 in those countries with higher CAPB (interaction CAPB-period 2012-2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012-2015, B: 0.25; p=0.004). Conclusions Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes.

  • 43. Rehm, Jürgen
    et al.
    Arbesu Prieto, Jose Angel
    Beier, Markus
    Duhot, Didier
    Rossi, Alessandro
    Schulte, Bernd
    Zarco, Jose
    Aubin, Henri-Jean
    Bachmann, Michael
    Grimm, Carsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Manthey, Jakob
    Scafato, Emanuele
    Gual, Antoni
    The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries2016In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, article id 130Article in journal (Refereed)
    Abstract [en]

    Background: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

  • 44.
    Ringer, Noam
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Living with ADHD: A Meta-Synthesis Review of Qualitative Research on Children’s Experiences and Understanding of Their ADHD2019Conference paper (Refereed)
    Abstract [en]

    Objective

    The aim of the following study was to systematically search for and review qualitative research on children’s and adolescents’ everyday experiences and understanding of their ADHD, and to suggest an integrative synthesis of the results.

    Methods

    The method that was used as a guide for the synthesis of the qualitative studies is the one suggested by Sandelowski and Barroso (2007). This broadly used method in the context of health-care research (Saini & Shlonsky, 2012) aims to systematically review and integrate the findings from various qualitative research reports and to suggest an understanding of the phenomenon in a manner entailing more than merely the sum of all the studies’ results (Sandelowski & Barroso, 2007). The method consists of three stages: firstly, a systematic search for and retrieval of qualitative research reports; secondly, a critical appraisal of the identified reports according to inclusion criteria; and thirdly, an interpretative integration of the findings of those studies regarded as eligible by creating a categorisation of these findings.

    Results / Discussion

    In total, 16 published and unpublished qualitative studies on the subject were identified. The analysis identified four categories: (1) experiences related to one’s body and psychological abilities: lack of control, having difficulties, and the biological determination of these experiences; (2) ambivalent experiences related to one’s own psychological needs: a need to adjust oneself and a need to be accepted as ‘who I am’; (3) ambivalent experience related to social others: demands and expectations are a problem, experiencing lack of belonging and stigma, but also receiving help from close social others; and (4) experiences related to the formation of personal identity.

  • 45.
    Ringer, Noam
    Stockholm University, Faculty of Social Sciences, Department of Education.
    Managing children with challenging behaviour. Parents' meaning-making processes in relation to their children's ADHD diagnoses2019Conference paper (Refereed)
    Abstract [en]

    Objective

    This study investigates parents’ lived experiences of having a child diagnosed with ADHD. The particular aim was to explore parents’ meaning -making processes in relation to their children’s ADHD with a focus on understanding the potential impact that receiving a diagnosis had on the parents’ perceptions of, and ways of managing, their children’s challenging behaviours.

    Methods

    Drawing on data collected through semi-structured interviews with 12 parents recruited to the study by school psychologists in Sweden, we carried out a content analysis of the parents’ accounts, producing a range of categories describing different aspects of the parents’ meaning-making processes in relation to their child receiving an ADHD diagnosis.

    Results / Discussion

    Five conceptual categories were identified, describing components of a process of adaptation through which the parents —using the diagnosis as a tool —were able to transform feelings of distress over their difficulties in managing their child’s challenging behaviours into feelings of being able to cope with these challenges of integrating the ADHD diagnosis into everyday family life.

  • 46. Rothlind, Erica
    et al.
    Fors, Uno
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Salminen, Helena
    Wändell, Per
    Ekblad, Solvig
    Circling the undefined - A grounded theory study of intercultural consultations in Swedish primary care2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 8, article id e0203383Article in journal (Refereed)
    Abstract [en]

    Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in intercultural consultations. In previous studies, intercultural consultations in primary care have often been described as complex for various reasons, but studies exploring physician-patient interactions contributing to the understanding of why they are complex are lacking. Therefore, the aim of this study was to explore intercultural physician-patient communication in primary care consultations, generating a conceptual model of the interpersonal interactions as described by both the patients and the physicians. Using grounded theory methodology, 15 residents in family medicine and 30 foreign-born patients, the latter with Arabic and Somali as native languages, were interviewed. The analysis generated a conceptual model named circling the undefined, where a silent agreement on issues fundamental to the core of the consultation was inadequately presumed and the communicative behaviors used did not contribute to clarity. This could be a possible contributory cause of the perceived complexity of intercultural consultations. Identifying what takes place on an interpersonal level in intercultural consultations might be a first step towards building a common ground for increased mutual understanding, thereby bringing us one step closer to sharing, rather than circling the undefined.

  • 47.
    Sarnecki, Jerzy
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Från vårdbehov till riskbedömningar2013In: Psykisk hälsa, ISSN 0033-3212, Vol. 54, no 1, p. 24-33Article in journal (Other academic)
  • 48. Sjöström, Susanne
    et al.
    Kopp Kallner, Helena
    Simeonova, Emilia
    Madestam, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Gemzell-Danielsson, Kristina
    Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, article id e0158645Article in journal (Refereed)
    Abstract [en]

    Objective The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. Study design A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. Results The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Conclusion Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.

  • 49. Stasinopoulos, Jacquelina
    et al.
    Bell, J. Simon
    Ryan-Atwood, Taliesin E.
    Tan, Edwin C. K.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Monash University, Australia.
    Ilomaki, Jenni
    Cooper, Tina
    Robson, Leonie
    Sluggett, Janet K.
    Frequency of and factors related to pro re nata (PRN) medication use in aged care services2018In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 14, no 10, p. 964-967Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the contribution of 'pro re nata' (PRN) medications to overall medication burden in residential aged care services (RACS). Objectives: To determine the frequency of, and factors associated with PRN medication administration in RACS. Measurements: Details of all medications charted for regular or PRN use were extracted from medication charts for 383 residents of 6 Australian RACS. Records of medications administered over a 7 day period were also extracted. Factors associated with PRN medication administration among residents charted >= 1 PRN were determined using multivariate logistic regression. Results: Of the 360 (94%) residents charted >= 1 PRN medication, 99 (28%) were administered PRN medication at least once. The most prevalent PRN medications were analgesics and laxatives. Residents with greater dependence with activities of daily living (ADL) (adjusted odds ratio (aOR) per additional point on Katz ADL scale: 0.80; 95% confidence interval (CI) 0.72-0.89; p < 0.001) and a greater number of regular medications (aOR per additional medication: 1.06; 95% CI 1.00-1.13; p = 0.042) were more likely to be administered PRN medication. Conclusions: Although most residents are charted PRN medications, rates of administration are relatively low, suggesting the contribution of PRNs to medication burden in RACS may be lower than previously thought.

  • 50.
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Market forces do not solve the problems: Commentary on Humphreys. K. & MCLellan. A.T. A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients2011In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 106, no 12, p. 2070-2071-Article in journal (Refereed)
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