Nordic School of Public Health
Goteborg, Sweden
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Forsman A.K.,Nordic School of Public Health
Scandinavian journal of public health | Year: 2011

To determine the associations between the cognitive aspects of social capital and mental health status in older adults. Data on older people (65 years of age or older, n = 1,102) were retrieved from a general population mental health survey conducted in Finland in 2008. The response rate was 61%. The associations between self-reported depression (measured by the Composite International Diagnostic Interview Short Form, CIDI-SF) or psychological distress (measured by the General Health Questionnaire, GHQ-12) and perceived social support, sense of belonging, and trust were tested by logistic regression analyses. For the cognitive social capital indicators, difficult access to help from neighbours showed a significant association with depression. Furthermore, not having people to count on, experiencing a lack of concern from other people, and feeling mistrust towards other people were all significantly associated with psychological distress. Links between mental health and cognitive social capital indicate that social support and trust may be important factors to consider when developing interventions to promote mental health and prevent mental disorders among older adults.

Ahgren B.,Nordic School of Public Health
Health Policy | Year: 2010

Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as " choice of care" This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is " local health care" , which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a non-competitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals. © 2010 Elsevier Ireland Ltd.

Povlsen L.,Nordic School of Public Health
Scandinavian Journal of Public Health | Year: 2012

Aims: To gain a deeper understanding of the conditions for and perceived benefits of regular participation in an immigrant women's club, with special focus on the women's wellbeing and the club's potential for health promotion. Methods: A qualitative research approach was applied, including semi-structured interviews, which were analysed using the constructivist Grounded Theory method. Individual interviews of 15 women aged 40-59 years and from various ethnic backgrounds were conducted in 2010/2011. Findings: Four categories were identified during the analysis. These were labelled "Forming a place for coping with loneliness" (core category), "Learning the rules", "Social bonding and support", and "A space for wellbeing and health". The categories describe how the members deal with the club's status as a municipal association, the structure of the meetings, and the informants' perceptions of being members of a club, as well as the effects of the membership. Conclusions: Immigrant women may find support and perceive increased wellbeing from gathering in clubs with women from a similar background. In addition, the clubs may provide society an opportunity and a space for adapted health-promotion initiatives. © 2012 the Nordic Societies of Public Health.

Aune I.,Norwegian University of Science and Technology | Moller A.,Nordic School of Public Health
Midwifery | Year: 2012

Objective: to increase our understanding of how pregnant women experience early ultrasound examination that includes a risk assessment for chromosomal anomalies and how such women perceive the test results. Design/setting: qualitative study at St. Olavs Hospital in Norway. Both pre- and post-examination interviews were conducted with ten pregnant women who underwent risk assessment for chromosomal anomalies. Grounded theory was used to analyse the results. Findings: the study generated a core category (I want a choice, but I don't want to decide), which related to the conflict between choice and decision making. There were also five main categories (existential choices, search for knowledge, anxiety, feeling of guilt and counselling and care). The main categories describe the complex feelings experienced by the women regarding the risk assessment. Factors contributing to the difficulty of choice included loss of control and coping, emotional connection to the fetus and social pressure. As the women sought independent choices without any external influence, they also felt greater responsibility. The women's understanding of the actual risk varied, and they used different types of logic and methods to evaluate the risk and reach a decision. Conclusions: the pregnant women in this study wanted prenatal diagnostic information and easy access to specialty services. Stress-related feelings and non-transparent information about the actual and perceived risks as well as personal moral judgments made the decision-making process complicated. Improved distribution of information and frequent contact with health professionals may help such women to make informed choices in accordance with their values and beliefs. © 2010 Elsevier Ltd.

Laursen T.M.,University of Aarhus | Laursen T.M.,Nordic School of Public Health
Schizophrenia Research | Year: 2011

The objective was to estimate life-expectancy (average age at death) among these persons and make a comparison to people in the general population. Methods: Life-expectancy was calculated by means of survival analysis techniques using the entire Danish population as a cohort. Results: Life-expectancy was 18.7. years shorter for schizophrenic men compared to men in the general population. Corresponding numbers for schizophrenic women was 16.3. years, for bipolar men 13.6. years, and for bipolar women 12.1. years. Conclusions: Life-expectancy was much shorter in persons with schizophrenia or bipolar disorder. Excess mortality from physical diseases and medical conditions exerts a far greater influence on the curtailed life-expectancy, when compared against the impact of death by external causes. © 2011 Elsevier B.V.

Povlsen L.,Nordic School of Public Health | Borup I.K.,Nordic School of Public Health
Scandinavian Journal of Caring Sciences | Year: 2011

Background: The concept of holism is central in health promotion as well as in nursing. Holism or a holistic view on health was identified as one of the key principles of the Ottawa Charter for Health Promotion and is linked to social ecology and the determinants of health. Aims: To explore how the term holism was defined and/or described in Nordic articles with a health-promotion approach, and how holism aspects were related to nursing and health promotion, and to the other key principles of the Ottawa Charter. Methods: Abstracts were first identified by the search word 'health promotion' as a keyword. The search was limited to 1986-2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for this study were subsequently selected from these abstracts using the search words 'holism' and 'holistic' and analysed by quantitative and manifest qualitative content analysis. Findings: The sample included 23 articles: one theoretical, two reviews and 20 empirical studies. Sixteen articles included a hospital setting or nursing perspective. A holistic perspective could be extracted from most articles. No larger but several minor differences were identified in the way holism aspects were related to nursing and health promotion respectively. Conclusion: There is a risk that the individual patient perspective of holism in nursing may result in less chance of reaching larger groups of patients with chronic diseases and mental health problems, not least the most vulnerable ones. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Lesen E.,Nordic School of Public Health
International psychogeriatrics / IPA | Year: 2011

The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited. An increased knowledge on this topic may contribute to improved prescribing patterns in this vulnerable population. The aim of this study was to assess the use of psychotropic drugs in relation to mental disorders and institutionalization among 95-year-olds and to identify use of potentially inappropriate psychotropic drugs. All 95-year-olds born in 1901-1903 living in nursing homes or community settings in Gothenburg, Sweden were invited to participate. The response rate was 65% and 338 95-year-olds were examined (263 women, 75 men). Psychotropic drug use in relation to mental disorders and institutionalization was assessed. Information on drug use was collected primarily from multi-dose drug dispensing lists. Participants were examined by trained psychiatrists using the Comprehensive Psychopathological Rating Scale and a battery of cognitive tests. Dementia, depression, anxiety and psychotic disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). Sixty percent of the 95-year-old participants used psychotropic drugs; hypnotics were most common (44%). Potentially inappropriate psychotropics were observed in one third (33%). Antidepressants were used by 7% of the participants without dementia who fulfilled criteria for a depressive disorder, while 56% used hypnotics and 30% used anxiolytics. The high prevalence of psychotropic drug use and the nonspecific nature of these treatments among 95-year-olds indicate a need for improvement in prescribing patterns.

Holmberg V.,Oslo University College | Ringsberg K.C.,Nordic School of Public Health
Scandinavian Journal of Occupational Therapy | Year: 2014

Objective: This study was undertaken to explore the views of occupational therapists concerning their competences in health promotion, and their perceptions of how they apply these competences in their daily work. The study also elicited their views on the contributions that occupational therapists could make to health promotion if given the opportunity. Methods: Data were collected in five focus-group discussions with 24 occupational therapists. These discussions were tape recorded and transcribed verbatim; data were analysed using qualitative content analysis. Results: The main findings are that the informants took an individualized salutogenic approach in their work and rarely engaged in health promotion on a systemic or societal level. They believed that their patients and collaborating partners, as well as public officials, remained unaware of their competences in health promotion. Conclusions: The findings of this study could enrich the discussion among occupational therapists on how they could make a more significant contribution to health promotion on a broader level. © Informa Healthcare.

Bjork E.,Nordic School of Public Health | Bjork E.,Gjøvik University College
Scandinavian Journal of Public Health | Year: 2014

Aims: The aim of this paper is to present the result of a pioneer project; A Nordic Charter for Universal Design, which was initiated by the Norwegian Directorate for Children, Youth and Family Affairs in 2011. The purpose of the Charter was to present rationales that stated prerequisites for successful investment in Universal Design, and to establish a platform for further research and good practice. It was also meant to contribute to spreading of information and knowledge about the importance of guidance by the concept of Universal Design of initiatives with effects on the public arena. Method: A Nordic group of researchers and professionals in the field ended up after 8 months of work with a written document: "A Nordic Charter for Universal Design", which was presented at the International Conference in Universal Design in Oslo, Norway (UD 2012). Result: A Nordic Charter for Universal Design. Conclusions: Persons with disabilities often experience the public arenas environments, products and services as poorly-designed to fit their abilities and/or their needs. Together with the demographic changes in the Nordic societies with an increasing number of elderly people, it needs initiatives to improve independence, accessibility and participation in society. A strategy which aims to make design and composition of different environments, products, communication, information technology and services accessible, usable and understandable to as many as possible is Universal Design. © 2013 the Nordic Societies of Public Health.

Ahgren B.,Nordic School of Public Health
Journal of Health, Organisation and Management | Year: 2010

Purpose: The purpose of this paper is to explore the concepts of Swedish integrated health care, their state of development and interdependence, and, furthermore, evaluate whether the theoretical framework used improves the comprehension of why integrated health care arrangements endure or cease. Design/methodology/approach: The study is founded on descriptive data gathered from a literature search on integrated health care in Sweden. With inspiration from ecology theory, these data were analysed guided by a theoretical model based on a continuum of symbiotic effects, from antagonism to mutualism. Findings: The era of Swedish integrated health care started in the 1990s, when a kind of clinical network called chains of care was launched. At the beginning the chain of care development was predominantly surrounded by non-integrative conditions, which had a restraining effect on these efforts. Even so, it seems that chains of care are here to stay. This faith in chains of care can to some extent be explained by the crucial role they have as connectors in the emerging local health care systems. Thus, these systems need chains of care to evolve and chains of care seem to require the integrative framework of local health care to progress and endure. Integrated health care performance could be troublesome, unless such mutualistic conditions are in place. States of commensalism may also be promoted, but the advantages are unilateral and therefore there is a risk of disloyalty by the unaffected part, which, in turn, can create a breeding-ground for an antagonistic liaison. Originality/value: A theoretical approach founded on what may be called "Health Care System Ecology" appears to enhance the understanding of the complex logic of integrated health care. © Emerald Group Publishing Limited.

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