County In Southern Sweden Research Articles

A registry study of oral health problems and preventive interventions among older persons receiving municipal healthcare - PROSENIOR.

The aim was to identify planned and completed preventive interventions among older persons with oral health problems receiving municipal health care. A further aim was to determine the correspondence between oral health problems and planned preventive interventions among older persons with oral health problems receiving municipal health care. Cross-sectional register study. Oral health data from the Swedish national quality registry, Senior Alert, were extracted for 4,024 older persons (≥65 years) receiving municipal health care in a county in Southern Sweden. Data were statistically analysed. A large majority of older persons (97.4%) with assessed oral health problems had at least one planned preventive intervention, and approximately three quarters of the planned interventions were completed. There seemed to be a mismatch between type of oral health problems and preventive interventions as not all older persons had a planned preventive intervention related to their specific oral health problem.

Professionals´ readiness for change to knowledge-based palliative care at nursing homes: a qualitative follow-up study after an educational intervention

BackgroundThere has been a global increase in the number of people who are dying of old age. This development implies a need for good palliative care among older persons at the end of life. Here nursing homes have an important role to play. However, the principles of palliative care have not been sufficiently applied in nursing homes, and there is a need to increase the implementation of palliative care in these settings. Therefore the project named Implementation of Knowledge-Based Palliative Care in Nursing Homes (the KUPA project, to use its Swedish acronym) was started as a contribution to filling this knowledge gap. The aim of the present study was to investigate the professionals’ experiences of readiness for change to knowledge-based palliative care at nursing homes after the educational intervention within the KUPA project.MethodsThe focus group method was used to interview 39 health-care professionals with the aid of semistructured questions based on the Organizational Readiness for Change theoretical framework. Six focus groups were formed at six nursing homes in two counties in southern Sweden. The groups included different types of professionals: assistant nurses, nurses, occupational therapists, physiotherapists and social workers. The analysis was conducted with an abductive approach and included deductive and inductive content analysis.ResultsThe analysis revealed one overarching theme: hopeful readiness for change in palliative care despite remaining barriers. The main categories were increased knowledge facilitating development, enhanced team spirit, uncertainty about future plans connected with hopeful readiness and remaining organizational barriers.ConclusionsThis study adds knowledge and understanding concerning professionals’ readiness for change palliative care in nursing homes and shows how ready nursing home settings undertake these changes in practice. The Organizational Readiness for Change theory proved suitable for application in nursing homes to assess the professionals’ experiences and to evaluate educational interventions regardless of the organization’s readiness for change.Trial registrationClinicalTrials NCT02708498, first registration 15/03/2016.

Prevalence and severity of differing dimensions of breathlessness among elderly males in the population.

Breathlessness is common in the general population. Existing data were obtained primarily with the uni-dimensional modified Medical Research Council breathlessness scale (mMRC) that does not assess intensities of unpleasantness nor physical, emotional and affective dimensions. The aim of this research was to determine the prevalence and intensity of these dimensions of breathlessness in elderly males and any associations with their duration, change over time and mMRC grade.We conducted a population-based, cross-sectional study of 73-year-old males in a county in southern Sweden. Breathlessness was self-reported at one time point using a postal survey including the Dyspnea-12 (D-12), the Multidimensional Dyspnea Profile (MDP) and the mMRC. Presence of an increased dimension score was defined as a score ≥minimal clinically important difference for each dimension scale. Association with the mMRC, recalled change since age 65, and duration of breathlessness were analysed with linear regression.Among 907 men, an increased dimension score was present in 17% (D-12 total score), 33% (MDP A1 unpleasantness), 19% (D-12 physical), 17% (MDP immediate perception), 10% (D-12 affective) and 17% (MDP emotional response). The unpleasantness and affective dimensions were strongly associated with mMRC≥3. Higher MDP and D-12 scores were associated with worsening of breathlessness since age 65, and higher MDP A1 unpleasantness was associated with breathlessness of less than 1 year duration.Increased scores of several dimensions of breathlessness are prevalent in 73-year-old males and are positively correlated with mMRC scores, worsening of breathlessness after age 65, and duration of less than 1 year.

Effect of an Educational Program on Healthcare Professionals' Readiness to Support Patients with Asthma, Allergies, and Chronic Obstructive Lung Disease for Improved Medication Adherence.

Purpose The aim of this study was to strengthen the healthcare professionals' readiness to support patients who have asthma, an allergy, and COPD for better medication adherence. Methods The design was an educational intervention in a study population (n = 70) consisting of 66 nurses and four other allied healthcare professionals working in primary care with patients diagnosed with asthma, allergy, or COPD in a county in southern Sweden. As part of two training days, an educational intervention—consisting of lectures and workshops—was conducted. Both qualitative and quantitative data were collected. The qualitative data were collected during the workshops when the participants worked with fictitious patient cases. They documented in writing how they, based on the theoretical content in the educational intervention in combination with their clinical experiences, reasoned that the fictitious patients could be supported for better adherence. This documentation constituted qualitative data. The quantitative data were collected through questionnaires, which the participants completed before and after the intervention. Data from the questionnaires were statistically analyzed using descriptive statistics and paired t-tests. The qualitative data collected from the workshops were analyzed with content analysis. Results The intervention increased the participants' knowledge of adherence (pre mean 3.95 versus post mean 4.18, p=0.001) and how to better support patients' adherence to medication (pre mean 3.71 versus post mean 3.98, p=0.001). Moreover, their knowledge of how to measure patients' adherence behavior (pre mean 3.02 versus post mean 3.54, p=0.001) and how to communicate with patients effectively about adherence was heightened (pre mean 3.92 versus post mean 4.13, p=0.011). Furthermore, participants felt that their readiness to support patients for better adherence had strengthened (pre mean 3.78 versus post mean 4.13, p=0.001). Individual adherence support for three fictitious patients with different adherence issues was developed. Conclusion An educational intervention focusing on adherence and communication equipped healthcare professionals with tools to support patients with asthma, an allergy, or COPD for better medication adherence.

Early and late signs that precede dying among older persons in nursing homes: the multidisciplinary team\u2019s perspective

BackgroundNursing home residents in Sweden are old, frail and usually have multiple morbidities which often make dying a prolonged suffering. It has been found that older persons at nursing homes receive far less palliative care than younger persons, partly because it is difficult to identify when the final stage of life begins. The identification may help the staff to enable the older person and their families to participate in planning the care in accordance with their own preferences and values. With this in mind the aim was to explore the experiences of early and late signs preceding dying in older persons in nursing homes from the multidisciplinary team’s perspective.MethodsThe focus group method was used to interview 20 health-care professionals on the basis of semi-structured questions. Four focus groups were conducted at four nursing homes in two counties in southern Sweden. The groups included different professionals such as assistant nurses, registered nurses, occupational therapists, physiotherapists, social workers and unit managers. The analysis was conducted according to the focus group method developed by Kruger and Casey.ResultsThe analysis revealed one major theme, from unawareness to obviousness, which illustrates that the participants experienced dying as a happening, not a process, and found it difficult to identify early signs. Even though it was a new way of thinking, several suggestions of early signs were presented. The main category “Going into a bubble” illustrates early signs, which meant that the older person showed signs of wanting to withdraw from the outside world. The main category “The body begins to shut down” illustrates late signs, which meant that the older person showed signs that indicate that the body starts to prepare for death.ConclusionsThis study conveys new knowledge concerning the multidisciplinary team’s collective experience of early and late signs that precede dying. This knowledge can increase the understanding of when a palliative care approach needs to be in place at nursing homes. The use of a palliative care approach in care planning requires consensus in the perception of the dying process of frail older persons.

Association between continuity of care in Swedish primary care and emergency services utilisation: a population-based cross-sectional study

Objective: The primary objective of this study was to determine the association between longitudinal continuity of care (CoC) in Swedish primary care (PC) and emergency services (ES) utilisation.Study design: A cross-sectional analysis of longitudinal population data. Setting. PC centres, out-of-hours PC facilities and emergency departments (EDs) in Blekinge County in southern Sweden. Subjects: People of all ages who lived in Blekinge County and who had made two or more visits per year to a general practitioner (GP) during office hours from 1 January 2012 to 31 December 2014.Main outcome measure: ES utilisation.Results: Eight-thousand one-hundred and eighty-five people were included in the study. CoC was quantified using three different indices—Usual Provider of Care index (UPC), Continuity of Care index (CoCI), and Sequential Continuity index (SECON). The CoC that the PC centres could offer their enrolled patients varied significantly between the different centres, ranging from 0.23–0.57 for UPC, 0.12–0.43 for CoCI, and 0.25–0.52 for SECON. Association between the three CoC indices and ES utilisation was computed as an incidence rate ratio which ranged between 0.50 and 0.59.Conclusion: Longitudinal CoC was shown to have a negative association with ES utilisation. The association was significant and of a magnitude that implies clinical relevance. Computed incidence rate ratios suggest that patients with the lowest CoC had twice as many ES visits compared to patients with the highest CoC.

Nurses' Use and Perception of an Information and Communication Technology System for Improving Coordination During Hospital Discharges: A Survey in Swedish Primary Healthcare.

To facilitate communications between care levels and improve coordination during hospital discharges, there is great potential in using information and communication technology systems, because they can significantly help to deter unnecessary readmissions. However, there is still a lack of knowledge about how often nurses use information and communication technology and the indicators related to its use. The aims of this study were to describe the indicators related to nurses' use of an information and communication technology system for collaboration between care levels and to estimate whether the level of use can be related to nurses' perceptions of the information and communication technology system's contribution to improve coordination during hospital discharges. A quantitative survey of 37 nurses from 11 primary healthcare centers was performed in a county in southern Sweden. The data were analyzed using descriptive and comparative analyses. The results showed that perceptions concerning the information and communication technology system's usability and time consumption differed between nurses who used the system and those who did not. Simultaneously, the nurses were rather unaware of the ability of the information and communication technology system to improve coordination during patient discharges.

Habitat network assessment of forest bioenergy options using the landscape simulator LandSim – A case study of Kronoberg, southern Sweden

Forest biomass is a renewable resource that is increasingly utilised for bioenergy purposes in Sweden, which along with the extraction of industrial wood may conflict with biodiversity conservation. The aim of this paper is to present a method for integrated sustainability assessment of forest biomass extraction, particularly from bioenergy and biodiversity perspectives. The landscape simulator LandSim was developed and linked with models for the assessment of biomass yields and habitat networks representing prioritised biodiversity components. It was applied in a case study in Kronoberg County in southern Sweden. Forest growth and management were simulated for the period 2010–2110, following two land zoning scenarios, one applying even-aged forest management on all forest land except for protected areas (EAF-tot), and one applying continuous cover forest management on parts of the forest land, combined with protected areas and an intensified even-aged management on the other parts (CCF-int). The EAF-tot scenario implied higher yields of biomass feedstock for bioenergy, the CCF-int scenario only giving 66% of that yield, while the CCF-int scenario performed substantially better when it came to the habitat network indicators, if habitat suitability was ensured. Conclusively, the case study confirmed that the modelling framework of the LEcA tool, linking the landscape simulator LandSim with the biomass yield assessment and the habitat network model can be used for integrating main policy concerns when assessing renewable energy options.

Abstract P191: Measurements of Large and Small Artery Elasticity Indexes in a Swedish Population: Are Repeated Measurements Needed?

Aim: The aim of this study was to investigate whether the repeated measurement of the pulse wave from the radial artery improve the precision of the estimated elasticity. Method: Between 2002 and 2005 a total of 2816 individuals (Men 1400) 35-74 years old, in the Skaraborg County in southern Sweden, were randomly selected for a health survey within the Skaraborg Project (the Vara-Skövde Cohort). All participants were examined with an oral glucose tolerance test (OGTT), blood pressure and anthropometric data. Pulse wave measurements were performed by two trained study nurses using the HDI/Pulse wave CR-2000 (Eagan, MN). Three repetitive measurements were performed within 5 minutes. Large and small artery elasticity indexes (LAEI and SAEI) from each measurement, as well as the mean value of the first two measurements and all three measurements were evaluated with intraclass correlation (ICC) and Pearsons correlation to investigate the precision of the test. Coefficient of variation (CV) was calculated for each measurement and for the variable of the mean of two first measurements and the mean of three measurements. Results: The measurements were successful in 2733 subjects (97%). The mean LAEI in 1st, 2nd and 3rd measurements were respectively 16.2±5.6ml/mmHg, 16.3±5.4 ml/mmHg and 16.5± 5.4 ml/mmHg and for SAEI the corresponding results were 7.4±3.6 ml/mmHg, 7.5±3.6 ml/mmHg and 7.4±3.5 ml/mmHg. A significant successive increase was observed in both the LAEI and the SAEI; comparing the third to the first examination LAEI-diff by 0.28 ml/mmHg CI 0.14-0.43 0 p<0.001, and SAEI by 0.17 ml/mmHg CI 0.1-0.24 p<0.001). The between measurement correlations for the LAEI were 0.73 and 0.76, and for the SAEI 0.85 and 0.88, respectively. The intraclass correlations were high both for LAEI (0.90 and 0.89) and for SAEI (0.95 and 0.96). The CV decreased from 33-35 in the single measurement to 30 using three measurements for LAEI and from 47-49 to 47 for SAEI. Conclusion: Considering the high CV in both LAEI and SAEI repeated measurements are recommended. However, the high correlation between the mean of two and three measurements suggests only slight improvement in the precision is achieved with three examinations. As commonly recommended for blood pressure control we suggest using the mean of two measurements also for these indices of arterial elasticity.

Association between age, gender and multimorbidity level and receiving home health care: a population-based Swedish study.

BackgroundHome health care is an important part of primary health care. How delivery of home health care is organised is probably important for sustainability of the healthcare system as a whole. More than 50 % of individuals over 65 years old have multimorbidity, which increases with higher age, also influencing the needs of home health care. Our aim was to study the proportion of the population above 65 years receiving home health care according to age, gender and multimorbidity level.MethodsThe study population comprised 32,130 people aged 65 or more, living in Blekinge County in southern Sweden. We analysed data from patient electronic medical records for patients receiving home health care delivered in patients’ own homes by nurses, physiotherapists and occupational therapists. We used the Adjusted Clinical Groups Case-Mix System in order to group individuals according to diagnoses into six levels of multimorbidity. In order to analyse the differences between individuals receiving home health care and those who did not, we used Chi squared test. Logistic regression analysis was conducted in order to study how the dependent variable was influenced by the independent variables.ResultsA total of 7860 (28 %) of the studied population received home health care in 2011. Logistic regression analysis showed that men had 26 % lower odds of receiving home care compared to women (OR = 0.74, 95 % CI 0.69–0.78). There was also a substantial group (22 %) with low multimorbidity level among people receiving home health care. Adjusting for gender and age showed no differences in odds of receiving home health care for patients with lower levels of multimorbidity. However, for patients with higher levels of morbidity the odds increased dramatically for both genders.ConclusionThe question of to whom and to what extent home health care should be provided is an important challenge for policy makers. Our results show that there are differences in the use of home health care dependent on gender, age and multimorbidity level, but also that home health care is provided to individuals with low morbidity. Further studies could explain the factors influencing home health care use.

Primary immunodeficiency in infection-prone children in southern Sweden: occurrence, clinical characteristics and immunological findings.

BackgroundPrimary immunodeficiency diseases (PIDs) comprise a heterogeneous group of disorders mainly characterized by increased susceptibility to infections. The aims of this study were to estimate the occurrence rate of PID in the paediatric (age ≤ 18 years) population of southern Sweden (approx. 265,000 children) and to describe their demographic, clinical and immunological characteristics. During a period of 4 years, in four paediatric speciality clinics in Skåne County in southern Sweden, children being seen for infections and fulfilling specific criteria were evaluated according to a predefined examination schedule. The initial analysis consisted of complete blood counts with analysis of lymphocyte subpopulations (T, B, NK cells), measurement of immunoglobulins (IgG, IgA, IgM, IgE and IgG subclasses), and assessment of the complement system (classical, alternative and lectin pathways). In addition, results of these immunological analyses in other children from the same area and time period were evaluated.ResultsIn total, 259 children (53.6% males) met the criteria and were included. The most common infection was recurrent otitis media. Immunological analyses results for about two thirds of the patients were outside age-related reference intervals. Further examination in this latter group identified 15 children with PID (9 males); 7 (2.7%) had genetically defined PID, representing 4 different diagnoses, and another 8 (3.1%) had a clinically defined PID - common variable immunodeficiency. No additional PID patient was identified from the evaluation of laboratory results in children not included in the study. The median age at diagnosis was 3.5 years (range 1–12 years).ConclusionsThe occurrence rate of PID was about 4 new cases per year in this population. Several different PID diagnoses were found, and the application of specified criteria to identify PID patients was useful. In children who are prone to infection, the use of a predefined set of immunological laboratory analyses at their first examination was beneficial for early identification of patients with PID.

“I'm Dr Jekyll and Mr Hyde”: Are GPs’ antibiotic prescribing patterns contextually dependent? A qualitative focus group study

Objective. To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design. Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting. Primary health care in two counties in southern Sweden. Subjects. Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures. Exploration of categories, determination of themes, construction of models. Results. The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions. The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.

SAT0253 Patients With Non-As Axial SPA Have Similar Prevalence Compared to as, But Worse Perceived Health. Results from a Population Based Study.

BackgroundNon-radiographic axial spondyloarthritis (SpA) is emerging as a treatable disease comparable to ankylosing spondylitis (AS), but less well studied. Previous studies have described a reversed gender distribution, with AS being...

When Blood Meets Nitrogen Oxides: Pregnancy Complications and Air Pollution Exposure

A number of studies have documented associations between maternal air pollution exposure and adverse birth outcomes such as low birth weight. However, only limited information exists for air pollution vis-a-vis pregnancy complications, which may share some underlying mechanisms with poor birth outcomes. A new study now reports an association between exposure to nitrogen oxides (NOX) and two pregnancy complications: gestational diabetes and preeclampsia (high blood pressure and protein in the urine) [EHP 121(4):488–493; http://dx.doi.org/1205736]. The study included women who gave birth during 1999–2005 in Scania, a county in southern Sweden. The women were included in the Swedish Medical Birth Registry, which consists of almost all infants born in Sweden; they comprised 81,110 singleton births, including 1,599 cases of gestational diabetes and 2,370 cases of preeclampsia. The investigators estimated mean monthly and trimester NOX exposures for each birth by combining emissions data with meteorological data. In addition, they used road traffic data from the Swedish National Road Database to calculate each woman’s proximity during pregnancy to heavily traveled roads. Gestational diabetes was assessed in relation to first or second trimester exposure to NOX, and preeclampsia was assessed in relation to NOX exposure during all three trimesters. Gestational diabetes is treated through diet and exercise. The only cure for preeclampsia is delivery; in severe cases, obstetricians will induce labor or perform a cesarean section. Both gestational diabetes and preeclampsia are potentially serious complications. ... Air pollution is relatively low in Scania, with ambient levels of NO2 (the dominant constituent of NOX and a proxy for the NOX family of compounds) well below the 40-µg/m3 annual standard set by the World Health Organization. In this study, the level of modeled NOX exposure averaged 16.4 µg/m3 over the entire study period, decreasing from 18.2 µg/m3 in 1999 to 13.3 µg/m3 in 2005. The researchers found an increased prevalence of gestational diabetes with each quartile of NOX exposure during the second trimester. Gestational diabetes was more common in urban versus nonurban subjects, but was increased among both urban and nonurban women with NOX above the average concentration for each population. Preeclampsia also was associated with increasingly higher levels of NOX exposure. The data suggested an association between gestational diabetes and proximity to high-traffic roads, although no obvious association was observed between traffic density and preeclampsia. The large sample size and individual NOX exposure estimates were strengths of the study, but confounding by factors related to socioeconomic status and other unmeasured characteristics could not be ruled out. The authors note that associations with the highest level of exposure were comparable in magnitude to those of other well-known risk factors such as obesity or being over 35 years of age. These findings, if reinforced with further research, could suggest the need to reduce exposures to pregnant women below current limits.

Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment: A qualitative study among primary care physicians in Sweden

Objectives. To improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs’ views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden. Design. Qualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis. Setting. Primary care in Kronoberg, a county in southern Sweden. Subjects. A purposeful sample of 20 GPs from 15 of 25 health centres in the county. Main outcome measures. The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs. Results. Three different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs’ perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice. Conclusion. There was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.

Impact of comorbidity on the individual's choice of primary health care provider

Objective. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting. The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects. A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. Main outcome measures. The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. Results. Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. Conclusions. This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC.

When do adolescents become smokers?

Objective. To follow the development of a class of pupils’ tobacco habits for seven years, and to study differences in tobacco use between girls and boys. Setting. Kronoberg County in southern Sweden. Subjects. All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. Design. Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. Main outcome measures. Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using “snus”, the Swedish variety of oral moist snuff. Results. From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of “snus”, and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. Conclusion. Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.

Marginal Valuation of Improving the Sport-Fishing Catch

This paper presents estimates of the marginal willingness-to-pay to improve sport-fishing conditions in a county in southern Sweden. Previous valuation studies have focused mainly on mean estimates, but policy decisions often require marginal values. The estimates are obtained by using the contingent valuation method within a parametric model that allows for zero willingness-to-pay values (a spike model). The data were collected using a mail survey sent to anglers in the county of Bohus in Sweden in 1998. The results show that the value of improved catch conditions depends on the type of angling and decreases at the margin when the catch increases. The marginal willingness-to-pay for catching an extra fish ranges from about SEK 5 (SEK 12 per kilo) for coastal angling to about SEK 530 (SEK 172 per kilo) for river angling (US$1 ≈ SEK 9). Such economic information is useful for managers with limited budgets who need to prioritize between different alternatives or actions to improve sport-fishing.

Satisfaction with mental health services. A user participation approach

User participation in the delivery and evaluation of mental health services has become an important policy element in the development of these services. An important area where user involvement could be especially useful concerns satisfaction with care, which has become considered an important indicator of service excellence. The overall aim of this study was to investigate user satisfaction with mental health services in a county in southern Sweden. The study design used persons with own experience from being a patient or a close relative to a patient as active participants in the data collection. A group of 20 persons with experience from being users or relatives to users were recruited and trained to be interviewers in the study. Together they performed 227 interviews focusing user satisfaction regarding both inpatient and outpatient care. The interview had one quantitative part and one qualitative part. The interviewers’ experiences from participation in the project were evaluated through focus groups. In these groups, the topics were the interviewers’ impression of the content of their interviews and their experience from being an interviewer. The analysis showed a high satisfaction with care in the quantitative part. In the qualitative part a significant dissatisfaction with many aspects of the care were expressed. The focus group evaluation largely supported the findings from the analyses of the dataset. Experiences of being user and interviewer were generally positive and perceived as rewarding.

Modelling the spread of penicillin‐resistant Streptococcus pneumoniae in day‐care and evaluation of intervention

In 1995, a disease control and intervention project was initiated in Malmöhus county in southern Sweden to limit the spread of penicillin-resistant pneumococci. Since most of the carriers of pneumococci are preschool children, and since most of the spread is believed to take place in day-care, a mathematical model, in the form of a stochastic process, for the spread in a day-care group was constructed. Effects of seasonal variation and size of the day-care group were particularly considered. The model was then used for comparing results from computer simulations without and with intervention. Results indicate that intervention is highly effective in day-care groups with more than ten children during the second half of the year.