Swedish Case Research Articles

Limiting bureaucratic discretion? Analyzing the design and exercise of administrative judicial review in the welfare sector

AbstractThis article develops a framework for understanding how the design of administrative judicial review can circumscribe the discretion of different bureaucratic actors. The framework proposes that bureaucratic discretion is limited to a great extent if courts can (i) overturn bureaucratic decisions on substantive grounds, (ii) review decisions associated with high economic costs, and (iii) issue detailed instructions for how rulings are to be implemented. Applying the framework to the Swedish case, we first show that the legislative design of the judicial review process allows administrative courts to greatly limit the discretion of senior officials and street‐level bureaucrats. Second, we show that Swedish courts defer to the expertise of bureaucratic actors in the welfare sector by sparingly overturning decisions. However, when courts actually overturn decisions, they frequently limit bureaucratic discretion by issuing detailed judgments in high‐cost cases, possibly undermining the conditions for good governance.

Fear of Crime as a Punitive Project—The Swedish Case

Fear of Crime as a Punitive Project—The Swedish Case

How Innovation Systems Promote and Hinder Innovations in Healthcare - a Swedish Case

Healthcare organizations must remain up-to-date when healthcare systems are in constant flux. One way to meet challenges is through innovations. The aim of this study is to explore what promotes and hinders the implementation of innovation in healthcare's complex organizational environment. An innovation system was studied through qualitative interviews with nine respondents. The results show that the implementation and adoption of innovations in healthcare are complex. The complexity of the innovation determines the likelihood and speed of the adoption among healthcare professionals. Promoters such as human and financial capital were seen as critical for the sustainability of the innovation. Evaluating the innovation through scientific processes was also important to gain legitimacy and is seen as an important contribution to research. The identifying promoters and hindrances are practical implications to prompt reflection on healthcare innovations among managers and healthcare professionals.

Loperamide positive deaths in Sweden 2012–2022 and Finland 2017–2022: Fatal loperamide intoxication exclusively for Sweden

Loperamide, a potent μ-opioid receptor agonist used as an antidiarrheal drug, exhibits increased bioavailability at supratherapeutic doses, causing potential central nervous system effects. Its misuse for opioid withdrawal relief and euphoria can lead to dangerously elevated blood levels, causing severe cardiac dysrhythmias and death. This study aimed to compare loperamide positive autopsy cases in Sweden and Finland after the introduction of postmortem toxicological analysis of loperamide, focusing on loperamide’s role in fatalities and identifying common characteristics among those affected. All cases with detected loperamide in femoral blood at forensic autopsies in Sweden (2012–2022) and Finland (2017–2022) were included. In Sweden, loperamide was detected in 126 individuals, and in Finland, in 111 individuals. The incidence of individuals positive for loperamide in postmortem femoral blood increased steadily over the study duration in both Sweden and Finland. Loperamide related fatalities were observed exclusively in Sweden (n=80), predominantly involving younger males with histories of substance abuse, typically classified as accidental deaths. The group of loperamide nonrelated deaths in Sweden mirrored the entirety of cases in Finland. The concentration of loperamide in postmortem femoral blood was significantly higher in cases where loperamide was considered the cause of death (median 0.140 μg/g) compared to cases where loperamide contributed (median 0.080 μg/g), as well as in deaths unrelated to loperamide in both countries (Sweden: median 0.029 μg/g; Finland: median 0.010 μg/ml). The high limit of quantification for loperamide in Sweden may underestimate therapeutic users in epidemiological assessments. This study underscores the absence of loperamide misuse in Finland and indicates a rising trend of loperamide abuse in Sweden.

Values of urban greening – Voices of residents on highly intensive densification (HID) in a Swedish case study

Effects of planned Highly Intensive Densification (HID) were investigated in southern Eriksberg, a residential area located four km from the city center, mainly built in the 1950s in western Uppsala, Sweden according to the planning ideal Houses-in-Park. Uppsala municipality has proposed a doubling of the number of apartments in the southern part of the residential area, mostly through situating dwellings in-between existing houses and in some of the existing green places and spaces. This way of densifying by inserting an equally large area is a new approach in larger Swedish cities, which we term HID. The research presented in this paper is based on case study methodology. Method triangulation has been used to elucidate the projected consequences on urban greening of the planned HID-process in southern Eriksberg. We have analysed the development plan of Eriksberg and measurable effects but also inventoried attitudes and experiences among residents. The document study showed that an implementation of the HID plan will transform the original concept Houses-in-Park into a compact design with significant smaller green spaces in between the houses. The main result showed that most of the respondents had in general strong opinions and feelings regarding the planned loss of green structure. The courtyard green, the district green and the entrance green were highly valued by the respondents. Further on it was clear that a majority were concerned about the residential area losing its original character, planned according to the idea, Houses-in-Park.

Lethal injuries in single stabs to the trunk – A study on homicides and suicides in Sweden

IntroductionHomicides using knives or other sharp objects are the most common type of homicide in Europe, and the second most common type of homicide worldwide. In contrast, suicides using sharp objects are rarer, constituting only a few per cent of all suicides in western countries. We investigated single stab injuries to the trunk in both homicides and suicides to assess differences in extent of injuries and in medical care, which could be of value for trauma management, public health and forensic assessment. MethodsWe identified all cases in Sweden between 2010 and 2021 that died of a single stab to the trunk, in either a homicide (n = 94) or a suicide (n = 45), and that were the subject of a forensic autopsy. We obtained data on demographics, hospital care and injured structures. To assess the severity of injuries, we applied AIS (Abbreviated Injury Score) and NISS (New Injury Severity Score). The inter-rater reliability of NISS between two raters was evaluated with intra-class correlation (ICC), with 95 % confidence intervals (CI). The data was analysed using Fisher's exact test, Mann-Whitney U test and logistic regression models. ResultsThe inter-rater reliability between the two NISS raters showed an ICC of 0.87 (95 % CI 0.68−0.95). We observed a larger variation of injuries in suicides, with a higher proportion of both unsurvivable (NISS 75) and minor injuries (NISS ≤ 8) (66.7 % and 8.9 % respectively) compared to in homicides (46.8 % and 0 % respectively). We observed a larger proportion of injuries to the heart in suicides (68.9% vs. 46.8 %, p = 0.018). In homicides, injuries involving vessels (52.1% vs. 13.3 %, p < 0.001) and hospital care (56.4 % vs. 8.9 %, p < 0.001) were significantly more common compared to suicides. Discussion and conclusionCausation (self-inflicted or assaults) seems to be associated with characteristics of injury and the likelihood of receiving hospital care. These findings could potentially be valuable for trauma management and forensic assessment of manner of death, however, determining the mortality of the injuries would require a comparison group comprising injured survivors.

Summary of seven Swedish case reports on the microwave syndrome associated with 5G radiofrequency radiation.

The fifth generation, 5G, for wireless communication is currently deployed in Sweden since 2019/2020, as well as in many other countries. We have previously published seven case reports that include a total of 16 persons aged between 4 and 83 years that developed the microwave syndrome within short time after being exposed to 5G base stations close to their dwellings. In all cases high radiofrequency (RF) radiation from 4G/5G was measured with a broadband meter. RF radiation reached >2,500,000 to >3,180,000 μW/m2 in peak maximum value in three of the studies. In total 41 different health issues were assessed for each person graded 0 (no complaint) to 10 (worst symptoms). Most prevalent and severe were sleeping difficultly (insomnia, waking night time, early wake-up), headache, fatique, irritability, concentration problems, loss of immediate memory, emotional distress, depression tendency, anxiety/panic, dysesthesia (unusual touched based sensations), burning and lancinating skin, cardiovascular symptoms (transitory high or irregular pulse), dyspnea, and pain in muscles and joints. Balance disorder and tinnitus were less prevalent. All these symptoms are included in the microwave syndrome. In most cases the symptoms declined and disappeared within a short time period after the studied persons had moved to a place with no 5G. These case histories are classical examples of provocation studies. They reinforce the urgency to inhibit the deployment of 5G until more safety studies have been performed.

Concept programmes to support healthcare design. Analysis and discussion of the Swedish case

Against the backdrop of the complex healthcare design process and the absence of national regulations on the functional and spatial organisation of healthcare facilities, this paper discusses the Swedish use of non-regulatory Concept Programmes, i.e. orientation tools for the conceptual stages of design conceived to facilitate the systematic transfer of knowledge from research and best practices to the design practice. A comparison is also made with the design approach and the norm in the Italian context, stimulating a two-fold debate on: the tools and methods needed to guide the design of primary care facilities; the process that should lead to the definition of such tools.

Distribution of benefits and adverse effects and their role in industrial symbiosis decision-making – A Swedish case study

Industrial symbiosis (IS) has been recognized as an important approach to succeed in the transition towards increased circularity in industry and society. IS involves collaboration between different actors sharing resources, aiming to minimize waste, improve resource and/or energy efficiency, resulting in reduced emissions and environmental impact. This study conducts an embedded single case study at an IS network in Sotenäs, Sweden, where both private and public actors collaborate by exchanging resources. The study identifies benefits and adverse effects of the IS network and explores how these are considered in the actors' decision-making regarding participation. The results indicate that different actors perceive different types and degrees of benefits and adverse effects. To add further value, this study develops an analytical framework for mapping benefits and adverse effects in the form of an impact assessment matrix. The framework maps at what level in society effects accrue and at what point in time they are expected to occur. The results of this study can help understand the role of specific benefits and adverse effects in actors’ decision-making, and show the distribution of effects across societal levels. This knowledge can help understand the complexity of IS networks and thereby facilitate the implementation of IS.

Financing green industrial transitions: A Swedish case study

Achieving global climate targets requires massive reductions in greenhouse gas emissions from energy-intensive industrial sectors. We investigate whether financing is an important obstacle for radical emission reduction in industry. We study Sweden as a case of a country that is comparatively advanced in its planning for transitions to low-carbon industrial production. We find that the size of capital investments or the availability of financing for these investments is not perceived as a significant obstacle. There are a number of factors explaining this, such as the fact that the companies involved in this study are well-established, large corporates, and hence well placed to finance their transition plans through conventional corporate finance channels, that conditions for market demand are good in the EU, and that many of the firms are in early stages of developing new technologies, when capital need is smaller compared to later stages. We also find that many financial actors express a strong appetite for sustainable investments. Finally, we observe that despite financing not being perceived as an obstacle, there is still a large and important role to play for public actors for reducing the risk of investments and accelerating the pace of change going forward.

#3018 Aciclovir or valaciclovir neurotoxicity in renal patients: increasing number of neurotoxicity cases are diagnosed in Sweden by a blood test

Abstract Background and Aims Kidney transplant patients are at high risk for developing zoster infections, as well as patients with impaired renal function. Aciclovir (ACV) and its prodrug valaciclovir are effective medications to treat these herpes infections. The medications typically have mild side effects such as nausea and vomiting, headache, and skin rash. More uncommon but serious side effects include elevated creatinine, acute kidney failure, and aciclovir-induced neuropsychiatric symptoms (AINS). The latter is difficult to distinguish from the viral infection treated, thus prolonged treatment with ACV may cause further deterioration and increase the chance for coma and need for intensive care treatment. ACV is excreted by glomerular filtration and tubular secretion and should be doses according to renal function. A small part is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase to its main metabolite 9-carboxymethoxymethylguanine (CMMG), but as renal function decreases more CMMG is found in the urine, serum, and CSF. We have earlier shown that a serum CMMG cut-off level of 10.8 µmol/L is predictive of AINS. Hemodialysis alleviates the symptoms dramatically, but AINS need to be diagnosed first. The knowledge about our method has increased in Sweden, but has more AINS cases been diagnosed in Sweden now than for 10 years ago? Method Data from our therapeutic drug monitoring (TDM) database of ACV and CMMG levels were studied during the period 2013 to 2023. Serum samples with a CMMG concentration above 10.8 µmol/L were collated and compared to the total number of samples per year. Some patients were monitored with more than one blood sample during the treatment period and the number of single patients was also included. Results The database consisted of 4521 serum ACV and CMMG samples during the study period with 727 samples with a CMMG concentration above 10.8 µmol/L. The number of CMMG serum samples increased from 278 in 2013 to 601 in 2023. A total of 363 patients had at least one sample above 10.8 µmol/L. A median of 33 (range 17 to 59) single patients were diagnosed with AINS per year. Conclusion Measurement of both ACV and CMMG has increased the number of AINS cases in Sweden and are requested to a higher extent now than 10 years ago. Two more laboratories in Sweden measure or will start to measure ACV and CMMG, one laboratory in Bristol have had the method since 2007, but there are too few laboratories performing the analysis in other countries, causing severe suffering for patients and high costs for healthcare.

Cohabitation and Marriage Formation in Times of Fertility Decline: The Case of Sweden in the Twenty-First Century

Developments over time in the prevalence of marriage and cohabitation formation has long received much interest, but less is known about more recent developments for different population subgroups in European countries. This applies as well to Sweden, a country considered a forerunner in family-demographic change. In contrast, much attention has been paid to the falling birth rates during the 2010s, and explanations that focus on the role of increasing uncertainties. In the Swedish case, the fertility decline has been documented across all main socio-demographic subgroups. The objective of this study is to examine whether the same situation holds for first marriage and cohabitation formation during the 2010s and the exceptional years of the Covid-19 pandemic. Based on Swedish population registers, including with new cohabitation data, we present annual indices of first marriage formation (1991–2022) and cohabitation formation (2012–2022) across a number of socio-demographic strata. We demonstrate a continuous decline in first marriage formation since the early 2010s with an additional sharp dip during the pandemic and a post-pandemic recovery. In contrast, there was a remarkable stability in cohabitation formation during 2012–2022. Although socio-demographic groups differ in their overall levels of marriage and cohabitation formation, the recent trends are strikingly similar across groups. Cohabiting couples, across population subgroups, have become less inclined to transition their union status to a more committed level, as manifested by marriage or parenthood. This occurred in spite of a positive economic climate in the 2010s and stable family policies, indicating that other forces are at play.

Using Optimization Modeling to Determine Locations for Aerial Firefighting Resources Based on Wildfire Risk Data

The increase of the global mean temperature likely leads to more frequent and prolonged fire weather periods, with hot and dry conditions. This would also lead to increased frequency and magnitude of wildfires, and increased risk of spatial and temporal co-occurrence. A key to control and suppress wildfires during fire weather is a strong initial response, for which aerial firefighting resources can be used. This paper investigates the potential of optimization modeling to support pre-wildfire location planning of aerial firefighting resources, by developing a binary integer programing model and test it on Swedish case data. The model produces useful results given considerably less amount of available input data to determine the locations, compared with the manual planning. With relatively short solution times, it shows potential to support fast relocation of resources during sudden changes of circumstances, and to facilitate implementation of a standard operating procedure, with less expert knowledge dependence.

Expectations on biochar as a climate solution in Sweden: Carbon dioxide removal with environmental co-benefits

While carbon dioxide removal is indispensable in net-zero climate policy, incentives to deploy removals are limited. Swedish public support to biochar is one exception. This paper draws on the Swedish case to explore expectations put on biochar and the significance of public support for fulfilling these expectations. The analysis shows that biochar is expected to contribute to several environmental objectives. However, while biochar producers and users voice expectations on strengthening the multifunctionality of landscapes, e.g., improved ecosystem resilience and reduced nutrient run-off, the authorities rather narrowly direct attention to the stability of biochar as a carbon storage. Nevertheless, public support is contributing to a small but important protective space for biochar development through three channels: First, through investment grants, which are crucial for the emerging Swedish biochar production capacity. Second, through demand-pull created by municipalities that specify high environmental safeguards, which favours domestic production over import. Third, indirectly through support of production facilities that enable intermediary activities for gathering and sharing knowledge. However, while recent changes to EU state aid regulation may be a game-changer, EU has until now acted as a barrier to support to carbon dioxide removal. This socio-technical regime resistance, combined with a lack of jointly articulated expectations on biochar, appear to have been preventing deployment on more significant scale.

An indicator framework to guide food system sustainability transition – The case of Sweden

Well-aligned food policies are needed at both national and international level to guide food system transformation towards sustainability. Rigorous indicator frameworks are essential in order to facilitate discussion of priorities, enable comparisons, assessment and progress monitoring, and ensure accountability. In this study, we develop a national framework for a sustainable food system, using Sweden as a case. Our framework, the Food System Sustainability House, advances the literature on sustainable food system frameworks in three distinct ways. Firstly, it is tailored to a specific national context (Sweden in our case); secondly, it distinguishes between impacts of domestic production arising within territorial boundaries and impacts related to Swedish consumption independent of country of origin; and thirdly, to facilitate policy priorities, it suggests how different dimensions of sustainability are interlinked at a conceptual level. From a scientific perspective, the Food System Sustainability House postulates the interlinkages between the societal objectives of the food system, the environmental foundations on which production takes place, and the economic system and governance which in the framework are suggested to function as enablers for an overall sustainable system. From a policy perspective, the framework provides a much-needed basis for assessing food system sustainability by suggesting indicators within a comprehensive set of sustainability themes at national level for monitoring distinct perspectives. It also provides the necessary basis for a discussion on how sustainability dimensions are interlinked.

Greenwashing within the Context of Nation Branding and National Reputation Management: Hennes&amp;Mauritz (H&amp;M) – A Swedish Case

Greenwashing within the Context of Nation Branding and National Reputation Management: Hennes&amp;Mauritz (H&amp;M) – A Swedish Case

Antibody-positive autoimmune encephalitis and paraneoplastic neurological syndrome: A Swedish case series.

This study aimed to explore the clinical characteristics and temporal disease course of patients with autoimmune encephalitis (AE) and paraneoplastic neurological syndrome (PNS) in Sweden. Thirty-seven antibody-positive AE and PNS cases were identified in the Healthcare region Mid Sweden between 2015 and 2019. Clinical data were collected through a retrospective review of electronic health records. Patients were divided into three subgroups based on antibody type: neuronal surface antibodies (NSAbs), onconeural antibodies, and anti-GAD65 antibodies. Nineteen patients had NSAbs, 11 onconeural antibodies, and seven anti-GAD65 antibodies. Anti-LGI1 and anti-NMDAR were the most frequently detected NSAbs, with anti-NMDAR cases having an older-than-expected age distribution (median age 40, range 17-72). Only 11 of 32 (30%) of patients had findings suggesting encephalitis on initial MRI, but 28 of 31 (90%) had pathological findings on initial cerebrospinal fluid analysis. All patients but one had abnormal EEG findings. Median time to immunotherapy was comparable among the three subgroups, whereas patients with anti-LGI1, anti-CASPR2, and anti-IgLON5 had an eightfold longer time to immunotherapy than anti-NMDAR and anti-GABA-B (p=.0016). There was a seasonal variation in onset for patients with non-tumor-related NSAbs and anti-GAD65 antibodies, with most patients (72%) falling ill in spring or summer. Swedish patients with AE and PNS had similar clinical characteristics as previously described cohorts from other geographical regions except for anti-NMDAR encephalitis, with older onset than expected. The onset of non-tumor-related AE occurred predominantly in the warm seasons, and AE with a more insidious onset was associated with delayed treatment initiation.

The fragmentation of climate change adaptation – the Sweden case

PurposeThis paper aims to challenge the view of Sweden’s climate leadership by problematizing its domestic climate adaptation governance and highlighting the need for a more holistic view of adaptation. The paper highlights aspects that are troublesome for not only the built environment along coastlines but also the future of Sweden’s standing as a climate leader. The paper concludes with recommendations addressing the key areas of climate adaptation fragmentation in Sweden and calls for a more holistic view of adaptation, and one that takes into account resources, collaboration and coherence of governance vision.Design/methodology/approachThe paper is a comprehensive analysis of internal governance processes in climate change adaptation. It is based on an extensive literature review and semi-structured interviews at the local level – i.e. municipalities – who have the primary responsibility for adaptation to climate change in Sweden.FindingsFindings point to three-fold concerns. First, there is a lack of clarity on roles and responsibilities in adaptation among municipalities, regions and governmental agencies. Second, the gap between available finance and actual needs for climate change adaptation presents a major challenge when channels and pathways are not clear either. Finally, some adaptation strategies on both the local and national scales may be maladaptive in the long term.Originality/valueSweden consistently ranks highly in different climate performance indices and has acquired an international reputation as a climate leader. The paper challenges this narrative. Through a closer look the paper’s findings reveal a more fragmented picture of climate adaptation governance in the country with a myriad of unresolved questions and ad hoc solutions, where adaptation challenges are more pronounced and manifest in the built environment along the coastlines.

Uncommon Variants in FLG2 and NOD2 Are Associated with Atopic Dermatitis in the Ethiopian Population

Loss-of-function variants in the filaggrin gene (FLG) have been identified as the strongest cause of susceptibility to atopic dermatitis (AD) in Europeans and Asians. However, very little is known about the genetic etiology behind AD in African populations, where the prevalence of AD is notably high. We sought to investigate the genetic origins of AD by performing whole-genome sequencing in an Ethiopian family with 12 individuals and several affected in different generations. We identified two variants within FLG2 (D13Y) and NOD2 (A918S) genes co-segregating with AD in the affected individuals. Further genotyping analyses in both Ethiopian and Swedish AD cases and controls revealed a significant association with the FLG2 variant (D13Y, p < 0.0013) only in the Ethiopian cohort. However, the NOD2 variant (A918S) did not show any association in our Ethiopian cohort. Instead, two previously recognized NOD2 variants (A849V, p < 0.0085, and G908R, p < 0.0036) were significantly associated with AD in our Ethiopian cohort. Our study indicates that the FLG2 and NOD2 genes might be important in the etiology of AD in Ethiopians. Additional genetic and functional studies are needed to confirm the role of these genes and the associated variants into the development of AD.

The need for a participatory recordkeeping system for children and young people placed in residential care homes: the case of Sweden

The need for a participatory recordkeeping system for children and young people placed in residential care homes: the case of Sweden