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  • 1.
    Ahnquist, Johanna
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, S-83140 Stockholm, Sweden.;Swedish Natl Inst Publ Hlth, Ostersund, Sweden..
    Wamala, Sarah P.
    Karolinska Inst, Dept Publ Hlth Sci, S-83140 Stockholm, Sweden.;Swedish Natl Inst Publ Hlth, Ostersund, Sweden..
    Lindstrom, Martin
    Malmo Univ Hosp, Malmo, Sweden.;Lund Univ, CED, S-22100 Lund, Sweden..
    Social determinants of health - A question of social or economic capital?: Interaction effects of socioeconomic factors on health outcomes2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 6, p. 930-939Article in journal (Refereed)
    Abstract [en]

    Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. (C) 2012 Elsevier Ltd. All rights reserved.

  • 2.
    Alessie, Rob J. M.
    et al.
    Univ Groningen, Groningen, Netherlands;Netspar, Tilburg, Netherlands.
    Angelini, Viola
    Univ Groningen, Groningen, Netherlands;Netspar, Tilburg, Netherlands.
    van den Berg, Gerard J.
    Uppsala University, Units outside the University, The Institute for Evaluation of Labour Market and Education Policy (IFAU). Univ Bristol, Bristol, Avon, England;IZA, Bonn, Germany.
    Mierau, Jochen O.
    Univ Groningen, Groningen, Netherlands;Netspar, Tilburg, Netherlands.
    Viluma, Laura
    Univ Groningen, Groningen, Netherlands.
    Economic conditions at birth and cardiovascular disease risk in adulthood: Evidence from post-1950 cohorts2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 224, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Much of the literature that studies long-run effects of early-life economic conditions on health outcomes is based on pre-1940 birth cohorts. Early in these individuals' lives, public social safety nets were at best rudimentary, and female labor force participation was relatively low. We complement the evidence by studying the effects of regional business cycle variations in the post-1950 Netherlands on cardiovascular disease risk in adulthood. We use data from Lifelines, a large cohort study that covers socio-economic, biological and health information from over 75,000 individuals aged between 20 and 63. Cardiovascular risk index is constructed from an extensive set of biomarkers. The results show that for women a 1 percentage point increase in the provincial unemployment level leads to a 0.02 percentage point increase in the risk of a fatal cardiovascular event in the coming 10 years while the effect in men is not significant. We conclude that women born in adverse economic conditions experience higher cardiovascular risk.

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

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

  • 4.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Childhood Peer Status and the Clustering of Social, Economic, and Health-related Circumstances in Adulthood2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 105, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Within the school-class context, children attain a social position in the peer hierarchy to which varying amounts of status are attached. Studies have shown that peer status – i.e. the degree of acceptance and likeability among classmates – is associated with adult health. However, these studies have generally paid little attention to the fact that health problems are likely to coincide with other adverse circumstances within the individual. The overarching aim of the current study was therefore to examine the impact of childhood peer status on the clustering of social, economic, and health-related circumstances in adulthood. Using a 1953 cohort born in Stockholm, Sweden (n = 14,294), four outcome profiles in adulthood were identified by means of latent class analysis: ‘Average’, ‘Low education’, ‘Unemployment’, and ‘Social assistance recipiency and mental health problems’. Multinomial regression analysis demonstrated that those with lower peer status had exceedingly higher risks of later ending up in the more adverse clusters. This association remained after adjusting for a variety of family-related and individual factors. We conclude that peer status constitutes a central aspect of children's upbringing with important consequences for life chances.

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

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

     

     

  • 6. Andersen, Ronald
    et al.
    Smedby, Björn
    Vågerö, Denny
    Cost containment, solidarity and cautious experimentation: Swedish dilemmas2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 52, p. 1195-1204Article in journal (Refereed)
    Abstract [en]

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

  • 7.
    Andersson, Elin M
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Liv, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?2024In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 341, article id 116530Article in journal (Refereed)
    Abstract [en]

    Background: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.

    Purpose: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.

    Method: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants’ (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0–10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.

    Results: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32–0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43–0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.

    Conclusion: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.

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  • 8. Backhans, Mona Christina
    et al.
    Burström, Bo
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Månsdotter, Anna
    Pioneers and laggards: Is the effect of gender equality on health dependent on context?2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, p. 1388-1395Article in journal (Refereed)
    Abstract [en]

    This study combines data at individual and area level to examine interactions between equality within couples and gender equality in the municipality in which individuals live. The research question is whether the context impacts on the association between gender equality and health. The material consists of data on 37,423 men and 37,616 women in 279 Swedish municipalities, who had their first child in 1978. The couples were classified according to indicators of their level of gender equality in 1980 in the public sphere (occupation and income) and private sphere (child care leave and parental leave) compared to that of their municipality. The health outcome is compensated days from sickness insurance during 1986-1999 with a cut-off at the 85% percentile. Data were analysed using logistic regression with the overall odds as reference. The results concerning gender equality in the private sphere show that among fathers, those who are equal in an equal municipality have lower levels of sick leave than the average while laggards (less equal than their municipality) and modest laggards have higher levels. In the public sphere, pioneers (more equal t han their municipality) fare better than the average while laggards fare worse. For mothers, those who are traditional in their roles in the public sphere are protected from high levels of sick leave, while the reverse is true for those who are equal. Traditional mothers in a traditional municipality have the lowest level of sick leave and pioneers the highest. These results show that there are distinct benefits as well as disadvantages to being a gender pioneer and/or a laggard in comparison to your municipality. The associations are markedly different for men and women.

  • 9.
    Banerjee, Albert
    et al.
    York University.
    Daly, Tamara
    York University .
    Armstrong, Pat
    York University.
    Szebehely, Marta
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Armstrong, Hugh
    Carleton University.
    LaFrance, Stirling
    Structural violence in long-term residential care for older people: Comparing Canada and Scandinavia2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 3, p. 390-398Article in journal (Refereed)
    Abstract [en]

    Canadian frontline careworkers are six times more likely to experience daily physical violence than their Scandinavian counterparts. This paper draws on a comparative survey of residential careworkers serving older people across three Canadian provinces (Manitoba, Nova Scotia, Ontario) and four countries that follow a Scandinavian model of social care (Denmark, Finland, Norway, Sweden) conducted between 2005 and 2006. Ninety percent of Canadian frontline careworkers experienced physical violence from residents or their relatives and 43 percent reported physical violence on a daily basis. Canadian focus groups conducted in 2007 reveal violence was often normalized as an inevitable part of elder-care. We use the concept of “structural violence”(Galtung, 1969) to raise questions about the role that systemic and organizational factors play in setting the context for violence. Structural violence refers to indirect forms of violence that are built into social structures and that prevent people from meeting their basic needs or fulfilling their potential. We applied the concept to long-term residential care and found that the poor quality of the working conditions and inadequate levels of support experienced by Canadian careworkers constitute a form of structural violence.Working conditions are detrimental to careworker's physical and mental health, and prevent careworkers from providing the quality of care they are capable of providing and understand to be part of their job. These conditions may also contribute to the violence workers experience, and further investigation is warranted.

  • 10.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Keenan, Katherine
    Grundy, Emily
    Kolk, Martin
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Myrskylä, Mikko
    Reproductive history and post-reproductive mortality: A sibling comparison analysis using Swedish register data2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 155, p. 82-92Article in journal (Refereed)
    Abstract [en]

    A growing body of evidence suggests that reproductive history influences post-reproductive mortality. A potential explanation for this association is confounding by socioeconomic status in the family of origin, as socioeconomic status is related to both fertility behaviours and to long-term health. We examine the relationship between age at first birth, completed parity, and post-reproductive mortality and address the potential confounding role of family of origin. We use Swedish population register data for men and women born 1932-1960, and examine both all-cause and cause-specific mortality. The contributions of our study are the use of a sibling comparison design that minimizes residual confounding from shared family background characteristics and assessment of cause-specific mortality that can shed light on the mechanisms linking reproductive history to mortality. Our results were entirely consistent with previous research on this topic, with teenage first time parents having higher mortality, and the relationship between parity and mortality following a U-shaped pattern where childless men and women and those with five or more children had the highest mortality. These results indicate that selection into specific fertility behaviours based upon socioeconomic status and experiences within the family of origin does not explain the relationship between reproductive history and post-reproductive mortality. Additional analyses where we adjust for other lifecourse factors such as educational attainment, attained socioeconomic status, and post-reproductive marital history do not change the results. Our results add an important new level of robustness to the findings on reproductive history and mortality by showing that the association is robust to confounding by factors shared by siblings. However it is still uncertain whether reproductive history causally influences health, or whether other confounding factors such as childhood health or risk-taking propensity could explain the association.

  • 11.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Myrskylä, Mikko
    Department of Social Policy, London School of Economics and Political Science, UK.
    Birth Order and Physical Fitness in Early Adulthood: Evidence from Swedish Military Conscription Data2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 123, p. 141-148Article in journal (Refereed)
    Abstract [en]

    Physical fitness at young adult ages is an important determinant of physical health, cognitive ability, and mortality. However, few studies have addressed the relationship between early life conditions and physical fitness in adulthood. An important potential factor influencing physical fitness is birth order, which prior studies associate with several early- and later-life outcomes such as height and mortality. This is the first study to analyse the association between birth order and physical fitness in late adolescence. We use military conscription data on 218,873 Swedish males born between 1965 and 1977. Physical fitness is measured by a test of maximal working capacity, a measure of cardiovascular fitness closely related to V02max. We use linear regression with sibling fixed effects, meaning a within-family comparison, to eliminate the confounding influence of unobserved factors that vary between siblings. To understand the mechanism we further analyse whether the association between birth order and physical fitness varies by sibship size, parental socioeconomic status, birth cohort or length of the birth interval. We find a strong, negative and monotonic relationship between birth order and physical fitness. For example, third-born children have a maximal working capacity approximately 0.1 (p<0.000) standard deviations lower than first-born children. The association exists both in small (3 or less children) and large families (4 or more children), in high and low socioeconomic status families, and amongst cohorts born in the 1960s and the 1970s. While in the whole population the birth order effect does not depend on the length of the birth intervals, in two-child families a longer birth interval strengthens the advantage of the first-born. Our results illustrate the importance of birth order on physical fitness, and suggest that the first-born advantage already arises in late adolescence.

  • 12.
    Bean, Christopher G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Winefield, Helen
    School of Psychology, University of Adelaide, Australia.
    Sargent, Charli
    Appleton Institute for Behavioural Science, Central Queensland University, Australia.
    Hutchinson, Amanda
    School of Psychology, Social Work and Social Policy, University of South Australia, Australia.
    Differential associations of job control components with both waist circumference and body mass index2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 13.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hensing, G
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    McKenzie, L
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Stridsman, A-K
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Prescribing benzodiazepines - a critical incident study of a physician dilemma.  1999In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 49, p. 459-467Article in journal (Refereed)
  • 14.
    Bengtsson, Staffan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    Bülow, Pia
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).
    The myth of the total institution: Written narratives of patients' views of sanatorium care 1908–19592016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 153, p. 54-61Article in journal (Refereed)
    Abstract [en]

    Drawing on written narratives by 72 former sanatorium patients, this article explores, from patients' perspectives, the nature of the relationships between patients and staff in a Swedish sanatorium during the first half of the twentieth century. These narratives are discussed in the context of the total institution. This article suggests that this phenomenon was marked by inconsistencies that can be understood in terms of its situational and contradictory characteristics. Simultaneously, these narratives are in opposition to the assumption of the static and powerless patient adapted only to suit the logic of the institution.

  • 15. Berg, Rigmor C.
    et al.
    Ross, Michael W.
    Malmö högskola, Faculty of Health and Society (HS).
    Weatherburn, Peter
    Schmidt, Axel J.
    Structural and environmental factors are associated with internalised homonegativity in men who have sex with men: Findings from the European MSM Internet Survey (EMIS) in 38 countries2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 78, p. 61-69Article in journal (Refereed)
    Abstract [en]

    Internalised homonegativity refers to a gay person's negative feelings about homosexuality and is believed to stem from negative societal stereotypes and attitudes towards homosexuality. Surprisingly, little research has centred on this link. In this research, we aimed to examine the associations between internalised homonegativity and structural forces, cultural influence, and access to sexual health promotion measures among a sample of 144,177 men who have sex with men (MSM) in 38 European countries. Participants were recruited as part of the European MSM Internet Survey (EMIS) during 2010. It was a self-completion, multilingual Internet-based survey for men living in Europe who have sex with men and/or feel attracted to men. Assumed causal relations were tested through multiple regression models. Variables at the structure of rule-systems (macro-level) that were significantly and negatively associated with internalised homonegativity were the presence of laws recognising same-sex relationships and same-sex adoption. In the meso-level model, greater proportions of the population expressing that they would not like to have homosexuals as neighbours predicted higher internalised homonegativity. In the last model, five variables were significantly and negatively associated with internalised homonegativity: being exposed to HIV/STI information for MSM, access to HIV testing, access to STI testing, access to condoms, and experience of gay-related hostility. In turn, men who had tested for HIV in the past year evidenced lower internalised homonegativity. This is the largest and certainly most geographically diverse study to date to examine structural and environmental predictors of internalised homonegativity among MSM. Our results show that one insidious consequence of society's stigma towards homosexuals is the internalisation of that stigma by gay and bisexual men themselves, thus, drawing attention to the importance of promoting social equity for self-acceptance around gay identity in building a positive sense of self.

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  • 16.
    Berglund, Anna Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Eisemann, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lalos, Ann
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Lalos, Othon
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Social adjustment and spouse relationships among women with stress incontinence before and after surgical treatment1996In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 42, no 11, p. 1537-1544Article in journal (Refereed)
    Abstract [en]

    Forty-five women with stress urinary incontinence (SUI) and their partners have been interviewed three months before and one year after surgical treatment to investigate the social consequences of their impairment. One year after surgery 76% of the women reported that they were cured (group A, n = 34) and 24% that they were improved (group B, n = 11). The cured women were significantly younger than the improved women. The duration of urinary leakage before the operation was significantly shorter in group A than in group B. One year post surgery group A reported a significantly decrease in impediments to exert certain tasks due to urine leakage. As concerns leisure time, group A reported a higher level of overall activities before surgery than group B, whereas postsurgery both groups obtained about the same level of activities. Regarding social support, no differences between the groups occurred as concerns attachment. Furthermore, group A women showed a significantly higher degree of adequacy of social integration compared with group B. The majority of the couples could openly discuss sexual matters with their partners and were satisfied with their sexual life. More than half of the interviewed men reported an increase in sexual desire one year after their partners operation. Whereas about every third woman in both groups reported an increase in sexual desire. However, the frequency of intercourse did not change in any groups. In conclusion, this study underlines the importance of social factors in the assessment of the consequences of stress urinary incontinence and its treatment.

  • 17. Berhane, Y
    et al.
    Gossaye, Y
    Emmelin, M
    Hogberg, U
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Women's health in a rural setting in societal transition in Ethiopia.2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 53, no 11, p. 1525-39Article in journal (Refereed)
    Abstract [en]

    There are reports indicating a worsening of women's health in transitional rural societies in sub-Saharan Africa in relation to autonomy, workload, illiteracy, nutrition and disease prevalence. Although these problems are rampant, proper documentation is lacking. The objective of this study was to reflect the health situation of women in rural Ethiopia. Furthermore, the study attempts to address the socio-demographic and cultural factors that have potential influence on the health of women in the context of a low-income setting. A combination of qualitative and quantitative research methods was utilised. In-depth interviews and a cross-sectional survey of randomly selected women were the main methods employed. The Butajira Rural Health Program demographic surveillance database provided the sampling frame. Heavy workload, lack of access to health services, poverty, traditional practices, poor social status and decision-making power, and lack of access to education were among the highly prevalent socio-cultural factors that potentially affect the health of women in Butajira. Though the majority of the women use traditional healers younger women show more tendency to use health services. No improvement of women's status was perceived by the younger generation compared to the older generation. Female genital mutilation is universal with a strong motivation to its maintenance. Nail polish has replaced the rite of nail-extraction before marriage in the younger generation. As the factors influencing the health of women are multiple and complex a holistic approach should be adopted with emphasis on improving access to health care and education, enhancing social status, and mechanisms to alleviate poverty.

  • 18. Bijlsma, Maarten J.
    et al.
    Tarkiainen, Lasse
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany: University of Helsinki,, Finland.
    Unemployment and subsequent depression: A mediation analysis using the parametric G-formula2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 194, p. 142-150Article in journal (Refereed)
    Abstract [en]

    The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.

  • 19.
    Billingsley, Sunnee
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Intragenerational mobility and mortality in Russia: Short and longer-term effects2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 12, p. 2326-2236Article in journal (Refereed)
    Abstract [en]

    This study uses the Russian Longitudinal Monitoring Survey to explore the relationship between mortality of men age 65 or younger and intragenerational mobility, measured objectively through household income and subjectively through social ranking. This relationship is considered in light of the social selection and social causation mechanisms developed in the literature as well as a proposed mechanism in which mobility itself is a consequential life event. The analysis spans the years 1994-2010, which covers the transitional period in Russia characterized by labor market restructuring and economic crisis as well as a later period of economic growth and recovery. Using Cox proportional hazard models, immediate and longer-term associations between mobility and mortality are estimated. Both subjective and objective downward mobility had an immediate positive association with mortality risk (increased by 44% and 24%, respectively). In contrast, upward mobility had a more pronounced effect over a longer-term horizon and lowered mortality risk by 17%. Controlling for destination status attenuated some associations, but findings were robust to the adjustment of selection-related factors such as alcohol consumption and health status in the year preceding mobility. Findings suggest that the negative relationship between upward mobility and mortality may be driven by social causation, whereas downward mobility may have an independent effect beyond selection or causation.

  • 20.
    Billingsley, Sunnee
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Intragenerational mobility and mortality in Russia: Short and longer-term effects2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 12, p. 2326-2336Article in journal (Refereed)
    Abstract [en]

    This study uses the Russian Longitudinal Monitoring Survey to explore the relationship betweenmortality of men age 65 or younger and intragenerational mobility, measured objectively throughhousehold income and subjectively through social ranking. This relationship is considered in light of thesocial selection and social causation mechanisms developed in the literature as well as a proposedmechanism in which mobility itself is a consequential life event. The analysis spans the years 1994e2010,which covers the transitional period in Russia characterized by labor market restructuring and economiccrisis as well as a later period of economic growth and recovery. Using Cox proportional hazard models,immediate and longer-term associations between mobility and mortality are estimated. Both subjectiveand objective downward mobility had an immediate positive association with mortality risk (increasedby 44% and 24%, respectively). In contrast, upward mobility had a more pronounced effect over a longertermhorizon and lowered mortality risk by 17%. Controlling for destination status attenuated someassociations, but findings were robust to the adjustment of selection-related factors such as alcoholconsumption and health status in the year preceding mobility. Findings suggest that the negative relationshipbetween upward mobility and mortality may be driven by social causation, whereas downwardmobility may have an independent effect beyond selection or causation.

  • 21.
    Binder, Pauline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Malmö University.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 11, p. 2028-2036Article in journal (Refereed)
    Abstract [en]

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

  • 22. Binder, Pauline
    et al.
    Johnsdotter, Sara
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Essén, Birgitta
    Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 11, p. 2028-2036Article in journal (Refereed)
    Abstract [en]

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

  • 23.
    Bjorkegren, Evelina
    et al.
    Stockholm Univ, Dept Econ, Box 514, S-10691 Stockholm, Sweden..
    Svaleryd, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics.
    Birth order and health disparities throughout the life course2023In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 318, article id 115605Article in journal (Refereed)
    Abstract [en]

    Background: Research has shown ample evidence of how birth order affects health; however, these studies focus on specific health outcomes and ages.

    Objective: We provide a comprehensive picture of the effects of birth order on health disparities over the life course.

    Method: We study the effects of birth order from birth to age 70 on hospitalizations, visits to open care facilities and mortality using Swedish register data from 1987 to 2016. We identify the effects by comparing siblings within the same family.

    Results: We find that firstborns have worse health at birth. In adolescence, the birth-order effects switch direction, and younger siblings are more likely to be hospitalized and visit open care facilities. From early age younger siblings receive more care for injuries, in adolescence for drug and alcohol abuse, and from middle age for diseases of the circulatory system compared to older siblings. Younger siblings also stay longer in hospital. Age 0-2, younger siblings are more likely to be hospitalized for infections, diseases of the respiratory system, eyes and ears, whereas the pattern is the opposite for children age 3-6. Firstborns are more likely to receive care for depression and ADHD in childhood and endocrine diseases after age 50.

    Interpretation: Birth order affects health over the life-cycle and this is likely due to biological factors as well as parental behavior and the family environment. Firstborns have worse health at birth, but in adolescence the effects switch direction due to health issues related to younger siblings engaging in more risky behavior. For small children, having siblings at home increases the risk of being hospitalized for infections, diseases of the respiratory system, eyes and ears. The adverse conditions in utero for firstborns may be the cause of increased risk of metabolic syndromes such as obesity and diabetes later in life.

  • 24.
    Björkegren, Evelina
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Svaleryd, Helena
    Birth order and health disparities throughout the life course2023In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 318, article id 115605Article in journal (Refereed)
    Abstract [en]

    Background: Research has shown ample evidence of how birth order affects health; however, these studies focus on specific health outcomes and ages.ObjectiveWe provide a comprehensive picture of the effects of birth order on health disparities over the life course.

    Method: We study the effects of birth order from birth to age 70 on hospitalizations, visits to open care facilities and mortality using Swedish register data from 1987 to 2016. We identify the effects by comparing siblings within the same family.

    Results: We find that firstborns have worse health at birth. In adolescence, the birth-order effects switch direction, and younger siblings are more likely to be hospitalized and visit open care facilities. From early age younger siblings receive more care for injuries, in adolescence for drug and alcohol abuse, and from middle age for diseases of the circulatory system compared to older siblings. Younger siblings also stay longer in hospital. Age 0–2, younger siblings are more likely to be hospitalized for infections, diseases of the respiratory system, eyes and ears, whereas the pattern is the opposite for children age 3–6. Firstborns are more likely to receive care for depression and ADHD in childhood and endocrine diseases after age 50.

    Interpretation: Birth order affects health over the life-cycle and this is likely due to biological factors as well as parental behavior and the family environment. Firstborns have worse health at birth, but in adolescence the effects switch direction due to health issues related to younger siblings engaging in more risky behavior. For small children, having siblings at home increases the risk of being hospitalized for infections, diseases of the respiratory system, eyes and ears. The adverse conditions in utero for firstborns may be the cause of increased risk of metabolic syndromes such as obesity and diabetes later in life.

  • 25. Björkenstam, Emma
    et al.
    Burström, Bo
    Brännström, Lars
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Björkenstam, Charlotte
    Pebley, Anne R.
    Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 142, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% Cl: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.

  • 26. Blaabæk, Ea Hoppe
    et al.
    Andersen, Lars Højsgaard
    Fallesen, Peter
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI). ROCKWOOL Foundation Research Unit, København, Denmark.
    From unequal injuries to unequal learning? Socioeconomic gradients in childhood concussions and the impact on children's academic performance2024In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 341, article id 116524Article in journal (Refereed)
    Abstract [en]

    Previous research identifies stark socioeconomic disparities in child injuries, yet research on the repercussions hereof on other aspects of children's lives remains sparse. This paper tests whether social gradients in minor traumatic brain injuries (mTBIs or concussions) contribute to corresponding inequalities in children's academic performance. Previous research on this topic is mostly based on small samples and confounded by non-random selection into experiencing mTBIs. We improve on prior research by using high quality, large N, administrative registry data. Further, we control for selection into having an mTBI via comparing the test score progression of children having an mTBI with children who experience an mTBI in later years (staggered difference-in-differences). Based on Danish ER/hospital records and national test score data, we find that children from families with lower earnings and less education are more likely to experience an mTBI and that having an mTBI negatively correlates with reading test scores. However, comparing present with future mTBI cases, we show that having an mTBI within a year before a test does not negatively affect children's reading scores. Our findings suggest that negative correlations between mTBIs and academic performance more likely reflect socioeconomic gradients in mTBI incidents rather than a direct causal effect. Further, socioeconomic gradients in mTBI incidents do not significantly contribute to corresponding disparities in academic performance.

  • 27. Blane, David
    et al.
    Netuveli, Gopalakrishnan
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Quality of life, health and physiological status and change at older ages2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 66, no 7, p. 1579-1587Article in journal (Refereed)
    Abstract [en]

    The relationship between self-reported health status and quality of life at older ages is well established. The present paper investigates this relationship further, using objective measures of health and their change over time in the English Longitudinal Study of Ageing, where positive quality of life at older ages was measured as CASP-19. Cross-sectionally, lung function and obesity, but not blood pressure, were associated with quality of life; these relationships in path analysis were transmitted primarily via functional limitation and more modestly, and only for lung function, via clinical depression. Longitudinally, the results suggest a stable and long-term influence on quality of life of lung function and, among women, body mass index, to which the influence of change may be cumulative; longer follow-up is required to clarify these processes. Overall, the results show that the relationship between health and quality of life is independent of potential psychological confounders, that functional limitation is the key dimension of health in its relationship with quality of life and that clinical depression may be an important mediator between functional limitation and quality of life.

  • 28.
    Blaschke, Sarah
    et al.
    Dept of Cancer Experiences Research, Univ of Melbourne.
    O'Callaghan, Clare
    Dept of Cancer Experiences Research, Univ of Melbourne.
    Schofield, Penelope
    Dept of Cancer Experiences Research, Univ of Melbourne.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Cancer patients' experiences with nature: Normalizing dichotomous realities2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 172, p. 107-114Article in journal (Refereed)
    Abstract [en]

    Aims: To explore cancer patients' subjective experiences with nature in order to examine the relevance of nature-based care opportunities in cancer care contexts. The rationale was to describe the underlying mechanisms of this interaction and produce translatable knowledge. Methods: Qualitative research design informed by grounded theory. Sampling was initially convenience and then theoretical. Competent adults with any cancer diagnosis were eligible to participate in a semi structured interview exploring views about the role of nature in their lives. Audio-recorded and transcribed interviews were analyzed using inductive, cyclic, and constant comparative analysis. Results: Twenty cancer patients (9 female) reported detailed description about their experiences with nature from which a typology of five common nature interactions emerged. A theory model was generated constituting a core category and two inter-related themes explaining a normalization process in which patients negotiate their shifting realities (Core Category). Nature functioned as a support structure and nurtured patients' inner and outer capacities to respond and connect more effectively (Theme A). Once enabled and comforted, patients could engage survival and reconstructive maneuvers and explore the consequences of cancer (Theme B). A dynamic relationship was evident between moving away while, simultaneously, advancing towards the cancer reality in order to accept a shifting normality. From a place of comfort and safety, patients felt supported to deal differently and more creatively with the threat and demands of cancer diagnosis, treatment and outlook. Conclusions: New understanding about nature's role in cancer patients' lives calls attention to recognizing additional forms of psychosocial care that encourage patients' own coping and creative processes to deal with their strain and, in some cases, reconstruct everyday lives. Further research is required to determine how nature opportunities can be feasibly delivered in the cancer care setting.

  • 29. Blomberg, Karin
    et al.
    Forss, Anette
    Ternestedt, Britt-Marie
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Tishelman, Carol
    From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear.2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 3, p. 479-86Article in journal (Refereed)
    Abstract [en]

    While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised.

  • 30.
    Blomberg, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Forss, Anette
    Ternestedt, Britt-Marie
    Örebro University, School of Health and Medical Sciences.
    Tishelman, Carol
    From 'silent' to 'heard': professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 3, p. 479-486Article in journal (Refereed)
    Abstract [en]

    While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised. (C) 2008 Elsevier Ltd. All rights reserved.

  • 31.
    Blomgren, Maria
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Sundén, Eva
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Constructing a European healthcare market: the private healthcare company Capio and the strategic aspect of the drive for transparency2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 10, p. 1512-1520Article in journal (Refereed)
    Abstract [en]

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

  • 32.
    Bodin, Maja
    et al.
    Centre for Sexology & Sexuality Studies, Malmö University.
    Björklund, Jenny
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research.
    “Can I take responsibility for bringing a person to this world who will be part of the apocalypse!?”: Ideological dilemmas and concerns for future well-being when bringing the climate crisis into reproductive decision-making2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 302, article id 114985Article in journal (Refereed)
    Abstract [en]

    In the wake of the ongoing climate crisis and its negative effects on public health, it has been questioned by climate activists whether it is right to bring more children into the world. Moreover, according to previous scholarship, having one fewer child is the most high-impact lifestyle change individuals in developed countries can make in order to reduce greenhouse gas emissions. But do climate awareness and recommendations to have fewer children have any impact on how lay people reason around reproductive decision-making? In this paper, which is based on focus group discussions with people from different generations, we show how various and sometimes conflicting discourses on reproductive norms and responsibility are negotiated. Even though participants were highly aware of the ongoing discussions around the climate crisis, in the end it had little bearing on their decision to have children or not, and they justified reproduction through addressing other ways to contribute to a better world.

    Download full text (pdf)
    fulltext
  • 33.
    Bodin, Maja
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Björklund, Jenny
    Centre for Gender Research, Uppsala University, Sweden.
    "Can I take responsibility for bringing a person to this world who will be part of the apocalypse!?": Ideological dilemmas and concerns for future well-being when bringing the climate crisis into reproductive decision-making.2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 302, article id 114985Article in journal (Refereed)
    Abstract [en]

    In the wake of the ongoing climate crisis and its negative effects on public health, it has been questioned by climate activists whether it is right to bring more children into the world. Moreover, according to previous scholarship, having one fewer child is the most high-impact lifestyle change individuals in developed countries can make in order to reduce greenhouse gas emissions. But do climate awareness and recommendations to have fewer children have any impact on how lay people reason around reproductive decision-making? In this paper, which is based on focus group discussions with people from different generations, we show how various and sometimes conflicting discourses on reproductive norms and responsibility are negotiated. Even though participants were highly aware of the ongoing discussions around the climate crisis, in the end it had little bearing on their decision to have children or not, and they justified reproduction through addressing other ways to contribute to a better world.

    Download full text (pdf)
    fulltext
  • 34.
    Bogg, Lennart
    et al.
    Mälardalen University, School of Health, Care and Social Welfare. Karolinska institutet.
    Huang, Kun
    Anhui Medical University.
    Shen, Yuan
    Xi'an Jiaotong University, China.
    Long, Qian
    Chongqing Medical University, China.
    Hemminki, Elina
    National Institute for Health and Welfare, Finland .
    Dramatic Increase of Cesarean Deliveries in the Midst of Health Reforms in Rural China2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, no 10, p. 1544-1549Article in journal (Refereed)
    Abstract [en]

    Cesarean delivery (CD) rates were until recently low in rural China where the population lacked healthinsurance. In July 2003 the New Cooperative Medical Scheme (NCMS) was introduced. We report findingsfrom a health systems study carried out in the EC-funded project ‘‘Structural hinders to andpromoters of good maternal care in rural China’’ in central and western China. The purpose was toanalyze how CD rates changed with the increased level of funding of the NCMS.The research design was a natural experiment. Quantitative demographic, administrative and accountsdata for 2001–2007 were collected in five counties from the county public health bureaux, the countyNCMS offices, the county statistical offices and the Maternal and Child Health (MCH) hospitals, usinga structured data collection form. We found that the CD rates increased in four of the five counties in theperiod 2004–2007 by 36%, 53%, 61% and 131% respectively. In the fifth county the CD rate remained highat 60%. The revenue from CD made up 72–85% of total delivery fee revenue. CD fee revenue increased by97%, 239% and 408% in the three counties with available data; a higher increase than in general healthcare revenue. Our conclusion is that the design of NCMS, the provider payment systems, and therevenue-related bonus systems for doctors need to be studied to rein in the unhealthy increases in ruralCD rates.

  • 35. Bolin, K
    et al.
    Lindgren, B
    Lindström, M
    Nystedt, Paul
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Management and Economics, Economics and Economic History.
    Investments in social capital - Implications of social interactions for the production of health2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 56, no 12, p. 2379-2390Article in journal (Refereed)
    Abstract [en]

    This paper develops a theoretical model of the family as producer of health- and social capital. There are both direct and indirect returns on the production and accumulation of health- and social capital. Direct returns (the consumption motives) result since health and social capital both enhance individual welfare per se. Indirect returns (the investment motives) result since health capital increases the amount of productive time, and social capital improves the efficiency of the production technology used for producing health capital. The main prediction of the theoretical model is that the amount of social capital is positively related to the level of health, individuals with high levels of social capital are healthier than individuals with lower levels of social capital, ceteris paribus. An empirical model is estimated, using a set of individual panel data from three different time periods in Sweden. We find that social capital is positively related to the level of health capital, which supports the theoretical model. Further, we find that the level of social capital (1) declines with age, (2) is lower for those married or cohabiting, and (3) is lower for men than for women.

  • 36.
    Bolin, Kristian
    et al.
    Lund University.
    Lindgren, Björn
    Lund University.
    Lindström, Martin
    Lund University.
    Nystedt, Paul
    University of Linköping.
    Investments in social capital - Implications of social interactions for the production of health2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 56, no 12, p. 2379-2390Article in journal (Refereed)
    Abstract [en]

    This paper develops a theoretical model of the family as producer of health- and social capital. There are both direct and indirect returns on the production and accumulation of health- and social capital. Direct returns (the consumption motives) result since health and social capital both enhance individual welfare per se. Indirect returns (the investment motives) result since health capital increases the amount of productive time, and social capital improves the efficiency of the production technology used for producing health capital. The main prediction of the theoretical model is that the amount of social capital is positively related to the level of health; individuals with high levels of social capital are healthier than individuals with lower levels of social capital, ceteris paribus. An empirical model is estimated, using a set of individual panel data from three different time periods in Sweden. We find that social capital is positively related to the level of health capital, which supports the theoretical model. Further, we find that the level of social capital (1) declines with age, (2) is lower for those married or cohabiting, and (3) is lower for men than for women.

  • 37.
    Bonander, Carl
    et al.
    University of Gothenburg, Sweden.
    Ekman, Mats
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Jakobsson, Niklas
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Vaccination nudges: A study of pre-booked COVID-19 vaccinations in Sweden2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 309, p. 1-11, article id 115248Article in journal (Refereed)
    Abstract [en]

    A nudge changes people’s actions without removing their options or altering their incentives. During the COVID-19 vaccine rollout, the Swedish Region of Uppsala sent letters with pre-booked appointments to inhabitants aged16–17 instead of opening up manual appointment booking. Using regional and municipal vaccination data, wedocument a higher vaccine uptake among 16- to 17-year-olds in Uppsala compared to untreated control regions(constructed using the synthetic control method as well as neighboring municipalities). The results highlight pre-booked appointments as a strategy for increasing vaccination rates in populations with low perceived risk.

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  • 38.
    Bosmans, Kim
    et al.
    Vrije Universiteit Brussel, Belgium.
    Vignola, Emilia F.
    City University of New York Graduate School of Public Health and Health Policy, USA.
    Álvarez-López, Valentina
    Universidad de Valparaiso, Chile.
    Julià, Mireia
    Universitat Pompeu Fabra, Spain; Hospital Del Mar Medical Research Institute, Spain.
    Ahonen, Emily Q.
    University of Utah School of Medicine, USA.
    Bolíbar, Mireia
    Universitat Pompeu Fabra, Spain; Universitat Autònoma de Barcelona, Spain.
    Gutiérrez-Zamora, Mariana
    Universitat Pompeu Fabra, Spain.
    Ivarsson, Lars
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Kvart, Signild
    Karolinska Institutet, Sweden.
    Muntaner, Carles
    Lawrence S. Bloomberg Faculty of Nursing, Canada.
    O’Campo, Patricia
    Karolinska Institutet, Sweden; Lawrence S. Bloomberg Faculty of Nursing, Canada; Li Ka Shing Knowledge Institute, Canada .
    Ruiz, Marisol E
    Universidad Austral, Chile.
    Vänerhagen, Kristian
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013).
    Cuervo, Isabel
    University of New York, USA.
    Davis, Letitia
    MA Department of Public Health, USA.
    Diaz, Ignacio
    Pontificia Universidad Católica de Chile, Chile.
    Escrig-Piñol, Astrid
    Universitat Pompeu Fabra, Spain; Hospital Del Mar Medical Research Institute, Spain.
    Gunn, Virginia
    Karolinska Institutet, Sweden; Unity Health Toronto, Canada; Cape Breton University, Canada.
    Lewchuk, Wayne
    McMaster University, Canada.
    Östergren, Per-Olof
    Lund University, Sweden.
    Padrosa, Eva
    Universitat Pompeu Fabra, Spain; Hospital Del Mar Medical Research Institute, Spain.
    Vílchez, David
    Universitat Pompeu Fabra, Spain.
    Vives, Alejandra
    Pontificia Universidad Católica de Chile, Chile; Pontificia Universidad Católica de Chile, Chile.
    Vos, Mattias
    Vrije Universiteit Brussel, Belgium.
    Zaupa, Alessandro
    Pontificia Universidad Católica de Chile, Chile.
    Bodin, Theo
    Karolinska Institutet, Sweden; Region Stockholm, Sweden.
    Baron, Sherry L.
    City University of New York, USA.
    Experiences of insecurity among non-standard workers across different welfare states: A qualitative cross-country study2023In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 327, article id 115970Article in journal (Refereed)
    Abstract [en]

    In recent decades, economic crises and political reforms focused on employment flexibilization have increased the use of non-standard employment (NSE). National political and economic contexts determine how employers interact with labour and how the state interacts with labour markets and manages social welfare policies. These factors influence the prevalence of NSE and the level of employment insecurity it creates, but the extent to which a country’s policy context mitigates the health influences of NSE is unclear. This study describes how workers experience insecurities created by NSE, and how this influences their health and well-being, in countries with different welfare states: Belgium, Canada, Chile, Spain, Sweden, and the United States. Interviews with 250 workers in NSE were analysed using a multiple-case study approach. Workers in all countries experienced multiple insecurities (e.g., income and employment insecurity) and relational tension with employers/clients, with negative health and well-being influences, in ways that were shaped by social inequalities (e.g., related to family support or immigration status). Welfare state differences were reflected in the level of workers’ exclusion from social protections, the time scale of their insecurity (threatening daily survival or longer-term life planning), and their ability to derive a sense of control from NSE. Workers in Belgium, Sweden, and Spain, countries with more generous welfare states, navigated these insecurities with greater success and with less influence on health and well-being. Findings contribute to our understanding of the health and well-being influences of NSE across different welfare regimes and suggest the need in all six countries for stronger state responses to NSE. Increased investment in universal and more equal rights and benefits in NSE could reduce the widening gap between standard and NSE. 

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  • 39.
    Bradby, Hannah
    University of Essex.
    Race, ethnicity and health: The costs and benefits of conceptualising racism and ethnicity2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 6, p. 955-958Article, review/survey (Refereed)
  • 40.
    Bradby, Hannah
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    ‘What do we mean by ‘racism’?: Conceptualising the range of what we call racism in health care settings: a commentary on Peek et al.2010In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 71, p. 10-12Article in journal (Refereed)
  • 41.
    Brenner, Sven-Olof
    et al.
    Luleå University of Technology.
    Levi, Lennart
    Department of Stress Research, Karolinska Institutet.
    Long-term unemployment among women in Sweden1987In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 25, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    Vulnerability at long-term unemployment is discussed and the results of a study of the effects of job loss and long-term unemployment among Swedish women are presented. Psychological and physiological data for the unemployed were sampled repeatedly over a two year period. Some of the unemployed were subject to an intervention programme aiming at buffering for the possibly negative effects of unemployment. Health data from matched control groups of employed were gathered over the same period. The results indicate a strong negative stress reaction at the job loss period, followed by a gradual adaptation to the conditions of unemployment as measured by biochemical and physiological health indicators. However, a substantial proportion of the unemployed compared to the employed showed a lower degree of psychological well-being and more severe depressive reactions. Recommendations are given concerning further research approaches on long-term unemployment. Policy implications to reduce vulnerability at long-term unemployment are discussed

  • 42.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Pros and cons of social relations: An analysis of adolescents’ health complaints2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 63, no 3, p. 611-623Article in journal (Refereed)
    Abstract [en]

    This paper examines the association between social relations and psychological and psychosomatic health complaints, among adolescents in Sweden. We focused on relationships with parents, as well as relationships with peers in school and in leisure time. Both the structure and the content of relations were analysed. For the latter, we looked at supportive as well as strained relations. The data was the pooled child supplements of the Swedish welfare surveys conducted in 2000–2003. This constitutes a nationally representative, cross-sectional sample of 10–18-year-olds (n=5137), where information was collected from both adolescents and their parents. Results showed that young people's social relations with parents and peers clearly covaried with their health complaints. With regard to family relations and psychological complaints, the association was more pronounced for relational content than for relational structure. For instance, whether relations with parents were strained or not seemed more relevant than family structure and parental working hours. Moreover, strained relations were more strongly associated with health complaints, especially psychosomatic complaints, than were supportive relations. This applied to relationships with parents as well as with peers in school.

  • 43.
    Broqvist, Mari
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    It takes a giraffe to see the big picture - Citizens' view on decision makers in health care rationing2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 128, p. 301-308Article in journal (Refereed)
    Abstract [en]

    Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The findings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens' views on rationing by (a) using a method that allows for reflection, (b) using the respondents' nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing. The main finding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferred where the views of different actors were considered important. The fact that politicians were seen as appropriate decision makers could be explained by several factors: the respondents' new insights about necessary trade-offs at the programme level, awareness of the importance of an overview of different health care needs, awareness about self-interest among different categories of decision-makers, including physicians, and the national context of long-term political accountability for health care in Sweden. This study points to the importance of being aware of contextual and methodological issues in relation to research on how citizens experience arrangements for rationing in health care.

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  • 44.
    Broström, Göran
    et al.
    Umeå University, Faculty of Social Sciences, Department of Statistics.
    Bengtsson, Tommy
    Department of Economic History, Lund University.
    Do conditions in early life affect old-age mortality directly and indirectly?: Evidence from 19th-century rural Sweden2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, no 9, p. 1583-1590Article in journal (Refereed)
    Abstract [en]

    Previous research has shown that the disease load experienced during the birth year, measured as the infant mortality rate, had a significant influence on old-age mortality in nineteenth-century rural Sweden. We know that children born in years with very high rates of infant mortality, due to outbreaks of smallpox or whooping cough, and who still survived to adulthood and married, faced a life length several years shorter than others. We do not know, however, whether this is a direct effect, caused by permanent physical damage leading to fatal outcomes later in life, or an indirect effect, via its influence on accumulation of wealth and obtained socio-economic status. The Scanian Demographic Database, with information on five rural parishes in southern Sweden between 1813 and 1894, contains the data needed to distinguish between the two mechanisms. First, the effects of conditions in childhood on obtained socio-economic status as an adult are analyzed, then the effects of both early-life conditions and socio-economic status at various stages of life on old-age mortality. By including random effects, we take into account possible dependencies in the data due to kinship and marriage. We find that a high disease load during the first year of life had a strong negative impact on a person's ability to acquire wealth, never before shown for a historical setting. This means that it is indeed possible that the effects of disease load in the first year of life indirectly affect mortality in old age through obtained socio-economic status. We find, however, no effects of obtained socio-economic status on old-age mortality. While the result is interesting per se, constituting a debatable issue, it means that the argument that early-life conditions indirectly affect old-age mortality is not supported. Instead, we find support for the conclusion that the effect of the disease load in early-life is direct or, in other words, that physiological damage from severe infections at the start of life leads to higher mortality at older ages. Taking random effects at family level into account did not alter this conclusion.

  • 45.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Understanding and preventing situations of abuse in health care: Navigation work in a Swedish palliative care setting2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 222, p. 52-58Article in journal (Refereed)
    Abstract [en]

    In their everyday work, health professionals find themselves in situations that they perceive to be abusive to patients. Such situations can trigger feelings of shame and guilt, making efforts to address the problem among colleagues a challenge. This article analyzes how health professionals conceptualize abusive situations, and how they develop collective learning and explore preventive strategies. It is based on an interactive research collaboration with a hospice and palliative care clinic in Sweden during 2016–2017. The empirical material consists of group discussions and participant observations collected during interactive drama workshops for all clinic staff. Based on three types of challenges in the material, identified through thematic analysis, we establish the concept of navigation work to show how health professionals prevent or find ways out of challenging and potentially abusive situations. First, the navigation of care landscapes shows how staff navigate the different territories of the home and the ward, reflecting how spatial settings construct the scope of care and what professionals consider to be potentially abusive situations. Second, the negotiation of collective navigations addresses the professionals' shared efforts to protect patients through the use of physical and relational boundaries, or mediating disrupted relationships. Third, the navigation of tensions in care highlights professionals’ strategies in the confined action space between coercing and neglecting patients who oppose necessary care procedures. Theoretically, the concept of navigation work draws upon work on care in practice, and sheds light on the particular kind of work care professionals do, and reflect on doing, in order to navigate the challenges of potentially abusive situations. By providing a perspective and shared vocabulary, the concept may also elicit ways in which this work can be verbalized, shared, and developed in clinical practice.

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  • 46.
    Calltorp, Johan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    How can our health systems be re-engineered to meet the future challenges? The Swedish experience2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 677-679Article in journal (Refereed)
    Abstract [en]

    All health systems confront challenges according to their respective level of development linked to social, demographic and economic factors as well as the pattern of disease and its burden on society. Among well developed, mature and highly industrialized countries, it is of great interest to exchange knowledge between countries on their respective economic and health status. In fact, international comparison is one of the main ways to learn how key health system components interact with basic social, economic and epidemiological components. However comparative research on health systems still needs development to improve our understanding of basic issues.

  • 47.
    Canvin, Krysia
    et al.
    University of Liverpool.
    Marttila, Anneli
    Karolinska institutet.
    Burstrom, Bo
    Karolinska institutet.
    Whitehead, Margaret
    University of Liverpool.
    Tales of the unexpected? Hidden resilience in poor households in Britain2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, no 2, p. 238-245Article in journal (Refereed)
    Abstract [en]

    Society tends to have low expectations for the health, employment, and family stability of people living in poverty and disadvantage, reinforced by a body of research focused on risk factors and negative outcomes. This ‘deficit model’ has pervaded policy and interventions to tackle inequalities in health, in particular in relation to area-based initiatives to improve the health of socio-economically disadvantaged communities. In contrast, the study presented here adopts a positive approach, specifically that of resilience, which we conceptualise as: the process of achieving positive and unexpected outcomes in adverse conditions. Taking account of the critiques of resilience research, we aimed to discover what could be learnt from a health inequalities policy perspective about resilience in poor households in Britain if: a) the voices of people experiencing hardship were heard; b) resilience was conceptualised as a process, rather than as a an individual trait; and c) the social context and conditions that helped or hindered that process of resilience were identified. We interviewed 25 adults with experience of material adversity and 18 social welfare workers with experience of working with people in these circumstances, as well as recording observations at the 13 fieldwork sites in England and Wales. The study provided many “tales of the unexpected” from participants living in disadvantaged circumstances. The participants recounted how they coped with very difficult situations, their achievements in these circumstances, the transitions they had made in their lives and what had helped them along the way. These transitions often occurred contrary to participants' and others' expectations. Interactions that promoted these transitions included family and community support, respectful attitudes and behaviour of service providers, and the chances offered to them to engage in activities that bolstered self-esteem. Recognition of such resilience, however, should complement, rather than detract from, wider societal efforts to reduce the material deprivation in which too many people within the population live.

  • 48.
    Carlson, Per
    Stockholms universitet.
    Educational differences in Self-Rated Health during the Russian Transition2000In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 51, no 9, p. 1363-74Article in journal (Refereed)
  • 49.
    Carlson, Per
    Sociologiska institutionen, Stockholms universitet.
    Educational diffrences in self-rated health during the Russian transition.2000In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 51, p. 1363-1374Article in journal (Refereed)
  • 50.
    Carlson, Per
    Stockholms universitet.
    Self-perceived health in east and west Europe: Another European health divide1998In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 46, p. 1355-1366Article in journal (Refereed)
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