Governance, Accountability, and Organizational Development: Eldercare Unit Managers' and Local Politicians' Experiences of and Responses to State Supervision of Swedish Eldercare.

This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV's narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

Adolescent self-reported health in relation to school factors: a multilevel analysis.

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.

Birth weight, domestic violence, coping, social support, and mental health of young Iranian mothers in Tehran.

The aim of this study was to investigate associations of birth weight with sociodemographic variables, domestic violence, ways of coping, social support, and general mental health of Iranian mothers. Six hundred mothers aged 15 to 29 years participated between June 2009 and November 2010. t-Test, analysis of variance, Spearman's correlation, and multiple regression were used. The results showed that there was no significant association between birth weight and general mental health of the mothers. Prenatal care visits, the mothers' history of having children with low birth weight (LBW), and weight gain during pregnancy were significantly associated with birth weight. The women who reported physical abuse during pregnancy had infants with lower birth weight. Satisfaction with social support and use of positive reappraisal were significantly associated with higher birth weight. In conclusion, a high quality of prenatal care and screening of pregnant women are recommended. Social environments good enough during pregnancy have protective effects against LBW.

Parents matter--but relations to parents do not explain gender differences in self-reported health in adolescents.

The aim of the study was to explore whether parent-adolescent relations are associated to self-reported health of adolescents. Logistic regression analyses were performed on a cross-sectional data set consisting of 5060 adolescents, grades 7-9, from six municipalities in the northern part of Sweden. The study was approved by the Regional Ethical Review Board in Umeå, Sweden. Results showed that, in both boys and girls, experiencing low parental demands as well as perceiving the relationship quality and the communication with parents as poor were significantly associated with having poor general health, somatic complaints and feelings of stress. In general, girls scored lower on self-reported health than boys, but our findings indicate that these gender differences could not be explained by relations to parents. In conclusion, relations to parents play an important role for self-reported health of adolescents. Although no causal-effect statements can be determined in this study, it is implied that there is a need for health professionals, such as school nurses, school welfare officers, etc., to pay special attention to parent-adolescent relations in their work with adolescents.

Norm compliance and self-reported health among Swedish adolescents.

AIMS: This study examines the relationship between norm compliance and self-reported health in adolescents, and how this differs between genders. Our specific aim was to investigate if extremely high norm compliance revealed any particular health patterns. METHODS: This empirical study used a web-based survey from 2005, which was distributed to all students (n = 5,066) in years 7-9 of compulsory school within six municipalities in northern Sweden. The respondents answered questions about their general health as well as specific health problems such as headaches, stomach ache, sleeping difficulties and stress. Compliance was measured according to different norm-related behaviour, such as truancy, crime and use of tobacco, alcohol and narcotics. RESULTS: The majority of respondents reported good health and norm-compliant behaviour. Girls reported more health problems than boys, a difference that increased with age. Those who were more norm compliant reported better health, fewer somatic complaints and less stress, which goes against our initial hypothesis that extremely high norm compliance and self-reported ill-health are related. There seemed to be a stronger relationship between self-reported health and norm compliance for girls than boys, in absolute terms. CONCLUSIONS: The results clearly show a relationship between norm compliance and health, and suggest inequalities between genders.

Priority dilemmas in psoriasis care and visions of a future care in a group of administrators, politicians and professionals in northern Sweden.

During the 1990s priority discussions were actualized in Sweden due to increased demands on health care and limited resources. In the county of Västerbotten in northern Sweden, with large rural areas, the decision makers faced special challenges due to distances and cost. Despite discussions striving for fairness in priorities, decision makers are still dealing with limited resources and difficult priority decisions regarding different diseases and treatments. In this study we aimed at describing views on priorities in public psoriasis care and visions of a future care among politicians, administrators and professionals in the county of Västerbottten in northern Sweden. Qualitative research interviews were performed with 23 key-persons. The findings revealed priority dilemmas about issues on organization, accessibility and ethics. Visions of a future care appeared as ambitions of a more effective care with good accessibility, continued research, information and a holistic approach in priorities. We conclude that dilemmas revealed in this study were a reflection of a gap between intentions and practice. In efforts to reduce these dilemmas we suggest methods with fairness in economic planning and priority setting, with concrete, official statements about the dominating views on which the priorities are based, and public information about these statements.

Marked by visibility of psoriasis in everyday life.

In this study, the authors aimed at a sociological approach to the individual's everyday life with psoriasis and to this end conducted qualitative interviews with 18 persons from a county in northern Sweden. The most difficult aspects of living with psoriasis were being marked by the visibility of psoriasis, especially in the younger ages, and the visibility of joint changes. Therefore, those with both rashes and joint changes felt marked and discredited in a twofold way. Commonly used coping strategies were routinization of both the treatment and the adjustment to the marking process, and acceptance, and these strategies developed with age. Most participants experienced a good quality of life but still could find nothing positive about psoriasis. The authors suggest efforts toward increased awareness among health care professionals of the marking process and future qualitative studies about experiences of psoriasis during adolescence.

Gatekeeping in child welfare: a comparative study of intake decisionmaking by social workers in Canada and Sweden.

This article details findings from social workers in Sweden and Canada, illuminating similarities and differences in gatekeeping in child welfare and child protection. Analysis revealed different patterns of inclusion and exclusion. Swedish child welfare includes a greater readiness to intervene with more resources and measures. Gatekeeping is assessment driven and focused on family preservation. In Canada, only the most needy children are eligible for a limited range of services. Gatekeeping is structure driven and narrowly focused on protection. Analyses of evidence-based research to improve outcomes for children and families must include comparisons of how different structural orientations influence management of referrals at intake. The authors discuss the implications of these findings.

Burnout among social workers in Iran: relations to individual characteristics and client violence.

Social workers are considered a professional group at high risk of burnout. Noticing the insufficient human resource management and understaffed social work centers, Iranian social workers are faced with a considerable level of physical and mental stress, which can lead to burnout. A national study on 390 social workers was conducted. Among social workers, 10.9% had experienced burnout and 17.4% are at risk of developing burnout. Social workers scored higher in burnout if they were dissatisfied with their income, had experienced violence, or had lower self-esteem. Findings are discussed with regard to Iranian context and recommendations for authorities of Iranian state welfare organizations are made.

Psoriasis care consumption and expectations from a gender perspective in a psoriasis population in northern Sweden.

The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1,060 subjects. The response rate was 74%. The relation between care consumption and studied variables was measured using regression and chi-square analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were fulfilled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decision-makers should provide for a maintained specialized care as well as a local health care system of high standard.

Determinants of quality of life in a psoriasis population in northern Sweden.

The aim of this study was to assess possible determinants of quality of life in psoriasis patients in northern Sweden, and to analyse the association between these determinants and quality of life. A questionnaire was mailed to 1,707 subjects, resulting in a response rate of 74%. The study is therefore based on 1,060 subjects, since 195 denied having psoriasis. Quality of life was measured using a version of the Dermatology Life Quality Index. The extent of the disease was estimated using the patients' sketches. The association between determinants and quality of life was calculated in a risk analysis using logistic regression. Large disease extent and joint symptoms were the strongest indicators for impaired quality of life. Other indicators were withdrawal from medical treatment due to distance to treatment facilities, which strongly influenced the quality of life and choice of treatment.