Municipalities In Southern Sweden Research Articles

Stages of PPP and Principal–Agent Conflicts: The Swedish Water and Sewerage Sector

ABSTRACTThe focus of this article is on public–private partnerships (PPPs). The aim is to both theoretically and empirically illustrate PPP agency problems in four PPP stages, as well as to identify potentially relevant solutions to the agency problems. The study employed a longitudinal case study of one PPP in a municipality in southern Sweden. Through an analysis based on interviews, observations, and documents, the study illustrates a number of agency problems faced by PPPs and highlights the importance of resource allocation, stakeholder management, and the creation of a common identity in reducing these problems.

Short-Term Associations between Air Pollution Concentrations and Respiratory Health—Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study

Acute effects of air pollution on respiratory health have traditionally been investigated with data on inpatient admissions, emergency room visits, and mortality. In this study, we aim to describe the total acute effects of air pollution on health care use for respiratory symptoms (ICD10-J00-J99). This will be done by investigating primary health care (PHC) visits, inpatient admissions, and emergency room visits together in five municipalities in southern Sweden, using a case-crossover design. Between 2005 and 2010, there were 81,019 visits to primary health care, 38,217 emergency room visits, and 25,271 inpatient admissions for respiratory symptoms in the study area. There was a 1.85% increase (95% CI: 0.52 to 3.20) in the number of primary health care visits associated with a 10 µg/m3 increase in nitrogen dioxide (NO2) levels in Malmö, but not in the other municipalities. Air pollution levels were generally not associated with emergency room visits or inpatient admissions, with one exception (in Helsingborg there was a 2.52% increase in emergency room visits for respiratory symptoms associated with a 10 µg/m3 increase in PM10). In conclusion, the results give weak support for short-term effects of air pollution on health care use associated with respiratory health symptoms in the study area.

PHR in health and social care for older people – regional development through learning within and across organisations

The study draws on findings from a series of seven participatory action research projects in community care for older people carried out over a period of eight years in 20 municipalities in southern Sweden. The analysis here looks at social impact across administrative levels and geographical scales. Different professional groups and care workers in community care participated, crossing divides between social work and health care. The participatory methods all involved a phase of individual reflection, a phase of reflection in practice with colleagues and mixed groups at the regional level, including unit managers and directors in some stages. Impacts concerned interprofessional learning and improved conditions for collaboration in care for older people across institutional boundaries as well as organisational learning across the municipalities. The action research approach was characterised by intensive work with values, empowering low-status professional groups. Social impacts were achieved beyond each project by benefitting from the multi-stakeholder design, using the structure of the organisations and the regional R&D department of the Association of Local Authorities. Over time, the different projects thus contributed to regional development ‘from below’. Nevertheless, employer perspectives tended to determine which conclusions from the projects were eventually implemented and prioritised. Continued reflective dialogue meetings between professional groups are therefore, needed as part of regular work processes. Local and regional structures need forms of autonomy that allow them to implement recommendations from participatory projects. Finally, employee perspectives need to be reflected in decision-making at all levels, particularly including low-status groups of care staff.

Integration of the ecosystem services concept in planning documents from six municipalities in southwestern Sweden

The ecosystem services (ES) concept refers to benefits that humanity receives from nature. Investigating how this concept has been embraced within urban planning is important when assessing the awareness of human dependence on natural functions and the potential for the ES concept to increase this awareness. We analyzed planning documents from three small and three large municipalities in southern Sweden to see how explicitly the ES concept was addressed and which individual services were mentioned. We found that five of the municipalities mentioned the ES concept explicitly and the remaining municipality addressed it implicitly. Comprehensive and green plans referred to the ES concept more explicitly than did plans that focused on a single issue. We used 23 individual ES as a reference; each was mentioned in at least one document, but those concerning habitat and recreation were mentioned most frequently. Individual ES were generally described at an elaborate level. No major differences were identified between large and small municipalities except that large ones mentioned more individual ES. Our study demonstrates that municipalities in southern Sweden have started to integrate the ES concept into their planning documents. However, there is great potential to increase and concretize the awareness of ES. (Less)

Coexisting Needs: Paradoxes in Collegial Reflection—The Development of a Pragmatic Method for Reflection

This paper addresses a feasibility study of a method for recurrent collegial reflection. A qualitative approach, using a participatory research design, was adopted. The collegial reflection was implemented in a school, in a middle‐sized municipality in southern Sweden, with 21 teachers participating in the intervention. Data collection included digital recordings of collegial reflection, open questions by mail, and individual interviews. Findings indicated one major theme, paradoxes in the design of the collegial reflection, and three categories: wanting to decide and wanting to be guided; meeting each other as teachers and/or as persons; and looking for the safe and/or looking for the new. Before implementing the method in another context, management needs to appreciate these contradictory experiences, allow for voluntary participation, address participants’ expectations, and allocate time and tasks. This study implicates that collegial reflection may contribute to teachers’ professional development, and it is thereby relevant to teachers’ classroom practice and pupils’ learning. We conclude that, by creating a structure which supports teachers’ collegial reflection, the school may function as a supportive environment, which may contribute to teacher retention.

Children of Parents With Serious Mental Illness: The Perspective of Social Workers

The aim of this study is to describe the experiences of children’s social workers in Sweden who work with families in which a parent suffers from serious mental illness, and how a child in such a family receives support. Data were collected through individual interviews and focus groups discussions with 13 professionals in 2 minor municipalities in southern Sweden. Interviewees stated that parental serious mental illness was not a main focus for children’s social workers. When parental serious mental illness became a barrier to caring for their children, the children’s social workers sought to collaborate with psychiatric services, but in many cases it did not turn out well. Providing support to the parent was one way of aiding the family, although at the price of setting the child’s perspective aside. Being faced with responsibility for the parent and the child left children’s social workers feeling they were the last outpost for the families. Children’s social workers require greater knowledge of how to handle parental serious mental illness, and more interagency collaboration with psychiatric services is needed to adequately support children of parents with a serious mental illness.

Strategies of Adolescent Girls and Boys for Coping With School-Related Stress.

Stress among adolescents in Western societies is becoming an issue of increasing concern of adolescent's health. The aim of this study was to gain greater knowledge about how girls and boys perceive and cope with school-related stress. Participants were 14- to 15-year-old adolescents from a medium-sized municipality in southern Sweden. The data were collected from focus group interviews. The data were subjected to qualitative content analysis. The findings show that adolescents "prioritizing the future or the present by making choices, finding their own private sphere to relax, and recovering with family and friends." There were gender differences in how these strategies were used. The findings could be used for initiating and planning health promotion interventions in school with focus on supporting girls' and boys' equal terms to cope with school-related stress in present and for the future and to give equal condition for future studies and opportunities in life.

Women's health in the Lund area (WHILA)--Alcohol consumption and all-cause mortality among women--a 17 year follow-up study.

BackgroundAlcohol consumption contributes to many negative health consequences and is a risk factor for death. Some previous studies however suggest a J-shaped relationship between the level of alcohol consumption and all-cause mortality. These findings have in part been suggested to be due to confounders. The aim of our study was to analyze the relationship between self-reported alcohol intake and all-cause mortality in women, adjusted for sociodemographic, lifestyle factors and diseases such as diabetes and previous ischemic heart disease.MethodsAll women aged 50–59 years (born between 1935 and 1945) that lived in any of the five municipalities in southern Sweden were invited to participate in a health survey. From December 1995 to February 2000 a total of 6916 women (out of 10,766, the total population of women in 1995) underwent a physical examination and answered a questionnaire. We followed the women from the day of screening until death, or if no event occurred until May 31st 2015. Mortality was ascertained through the national cause-of-death register.ResultsIn this study a total of 6353 women were included. Alcohol consumption showed a J-formed relationship with mortality, when adjusted for education, marital status, smoking, BMI, physical fitness, diabetes and ischemic heart disease before screening. Non consumption of alcohol was associated with increased mortality as well as higher levels of consumption, from 12 grams per day and upwards.ConclusionsThere was a clear J-shaped relation between the amount of alcohol consumption and all-cause mortality even after controlling for sociodemography, lifestyle factors and diseases such as diabetes and previous ischemic heart disease. The observed protective effect of light drinking (1–12 grams/day) could thus not be attributed to any of these known confounders.

Local levers for change: Mainstreaming ecosystem-based adaptation into municipal planning to foster sustainability transitions

Unprecedented global challenges demand wide-reaching societal modification to ensure life support functions and human well-being. In the absence of adequate international responses to climate change and the need for place-based adaptation, local governments have a pivotal role in fostering sustainability transitions. In this context, the importance of ecosystem-based adaptation is increasingly recognized as a multi-benefit approach that utilizes ecosystem services to harmonize human-environment systems. Although research advocates the mainstreaming of ecosystem-based adaptation to advance sustainable planning, the pathways for its systematic implementation are missing and it remains unclear how local authorities can best integrate this new approach into their core work. The purpose of this study is to increase knowledge of the potential ways to mainstream ecosystem-based adaptation into municipal planning. We investigate four coastal municipalities in southern Sweden (Malmö, Helsingborg, Lomma and Kristianstad) and examine, based on vertical and horizontal integration processes, the key characteristics of existing mainstreaming strategies. Results show that, although ecosystem service planning and climate change adaptation planning together establish the conceptual foundation for ecosystem-based adaptation, related activities are often implemented separately and are rarely comprehensive. We illustrate how combined mainstreaming strategies can reinforce and complement each other and how strong leadership in the integration of processes has the ability to compensate for a lack of guidance or supporting legislation from higher decision-making levels. Finally, we conclude that systemic mainstreaming of sustainability issues is a promising avenue for initiating and promoting sustainability transitions and has the potential to address the criticism that other mainstreaming topics have faced. On this basis, we specify the core characteristics necessary to ensure its effective and meaningful application.

Effects on healthcare utilization of case management for frail older people: A randomized controlled trial (RCT)

ObjectivesVarious healthcare interventions have been launched targeting the growing population of older people. The objective of this study was to investigate the of a case management intervention for frail old people (aged 65+ years) effects on healthcare utilization. Materials and methodsThe study was conducted in a municipality in southern Sweden and included people aged 65+ years who lived in their ordinary homes, were dependent in two or more activities of daily living (ADL), and had at least two hospital admissions, or four physician visits, in the previous year. One-hundred-fifty-three participants were randomly assigned to either an intervention (n=80) or a control group (n=73). The one-year intervention comprised home visits, at least once a month, by case managers. Group differences were investigated 6–12 and 0–6 months before, and 0–6 and 6–12 months after, baseline. ResultsThe intervention group had, compared to the control group, significant lower mean number (0.08 vs. 0.37, p=0.041) and proportion (17.4 vs. 46.9%, p=0.016) of ED visits not leading to hospitalization 6–12 months after baseline. The intervention group also had a significantly lower mean number of visits to physicians in outpatient care 6–12 months after baseline (4.09 vs. 5.29, p=0.047). ConclusionThe effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization, suggesting that they may have been less monitored than the intervention group. The intervention has the potential to reduce the burden on outpatient care and ED.

High degree of BMI misclassification of malnutrition among Swedish elderly population: Age-adjusted height estimation using knee height and demispan.

Background/Objectives:The degree of misclassification of obesity and undernutrition among elders owing to inaccurate height measurements is investigated using height predicted by knee height (KH) and demispan equations.Subjects/Methods:Cross-sectional investigation was done among a random heterogeneous sample from five municipalities in Southern Sweden from a general population study ‘Good Aging in Skåne' (GÅS). The sample comprised two groups: group 1 (KH) including 2839 GÅS baseline participants aged 60–93 years with a valid KH measurement and group 2 (demispan) including 2871 GÅS follow-up examination participants (1573 baseline; 1298 new), aged 60–99 years, with a valid demispan measurement. Participation rate was 80%. Height, weight, KH and demispan were measured. KH and demispan equations were formulated using linear regression analysis among participants aged 60–64 years as reference. Body mass index (BMI) was calculated in kg/m2.Results:Undernutrition prevalences in men and women were 3.9 and 8.6% by KH, compared with 2.4 and 5.4% by standard BMI, and more pronounced for all women aged 85+ years (21% vs 11.3%). The corresponding value in women aged 85+ years by demispan was 16.5% vs 10% by standard BMI. Obesity prevalences in men and women were 17.5 and 14.6% by KH, compared with 19.0 and 20.03% by standard BMI. Values among women aged 85+ years were 3.7% vs 10.4% by KH and 6.5% vs 12.7% by demispan compared with the standard.Conclusions:There is an age-related misclassification of undernutrition and obesity attributed to inaccurate height estimation among the elderly. This could affect the management of patients at true risk. We therefore propose using KH- and demispan-based formulae to address this issue.

Planning for future sea-level rise in Swedish municipalities

A warmer climate leads to rising sea levels. Despite uncertainties about how rapid and substantial future sea-level rise (SLR) will be, society needs to prepare and adapt. This study examines the state of planning for future SLR in Sweden by surveying 33 coastal municipalities in southern Sweden and interviewing local, regional and national authorities with relevant accountability. The results reveal that there are considerable gaps in current planning for SLR. Almost one-third of municipalities lack guiding planning documents for SLR, and more than two-thirds do not discuss SLR beyond 2100. We argue that the prevailing uncertainty and ambiguity in assessments of future SLR is problematic within a traditional “predict-then-act” paradigm, and that robust approaches, such as scenario planning, can reduce many of these problems.

Participation in Day Centres for People with Psychiatric Disabilities — A Focus on Occupational Engagement

Background:Day centres are central for community participation among people with mental health problems. Understanding day centre attendees' occupational engagement is therefore important.Method:A total of 88 people from six day centres in four municipalities in southern Sweden completed a time-use diary, recording their occupational engagement during the most recent day at the day centre. The transcribed data were analysed using thematic content analysis.Findings:The main theme was being part of the spirit of togetherness and getting empowered, from which the participants' reflections could be understood.Conclusion:The day centres provided opportunities to be occupationally engaged and to create routines, and challenged the attendees to be more active in their daily life. Day centres have the potential to provide empowering occupations and rehabilitation for people with mental health problems and to help them towards a more participatory life.

How the professionals can identify needs for improve- ment and improve Food Distribution service for the home-living elderly people in Sweden - an action research project

Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden. Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method. Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved. Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.

In search of legitimacy – registered nurses’ experience of providing palliative care in a municipal context

The palliative care approach was originally developed for hospice care and for persons with cancer diseases, but has gradually expanded to embrace other contexts and people of all ages, with various life-threatening diseases. The palliative care concept thus also applies to older people and the context of municipal care, where Registered Nurses (RNs) hold key care provision positions. The municipal context is not, however, focused primarily on advanced nursing care, and it is important to highlight RNs' prerequisites for care provision. The study's aim was to describe RNs' experience of providing palliative care for older people in a municipal context. Data were collected through focus group discussions with 20 RNs from four different municipalities in southern Sweden and were analysed using conventional content analysis. The results showed that the nurses experienced that it was they who cushioned the effects of unclear responsibilities between different organizations, but had limited legitimacy in the municipal context and in relation to other care providers. The results also showed that nurses lacked proper support and prerequisites for providing high-quality palliative care to older dying patients. The results pinpoint the importance of increased acknowledgement of nurses' knowledge and skills and a critical view on the effects of moving towards an organization composed of different consultants, which can lead to even more unclear responsibility for nursing care provision.

Patterns and Challenges of Urban Nature Conservation—A Study of Southern Sweden

The current, dominating strategy of nature conservation within urban landscapes is to formally protect remaining patches of unexploited nature in nature reserves. However, integration of nature conservation frameworks into urban planning requires reconsideration of key issues, such as why, where, and how to protect nature in a purposeful way. As part of that process I statistically evaluate current nature conservation in 209 municipalities in southern Sweden by analysing the number, size, age, and land cover patterns of 1869 nature reserves in relation to the degree of urbanisation. The analyses reveal that in urban municipalities the nature reserves are fewer, but larger, and have a higher diversity of land covers. Having large nature reserves may be especially important in urban landscapes, since it is often highly fragmented. The land cover compositions show no differences between urban and rural nature reserves. However, urban nature reserves differ more from their surroundings compared with rural nature reserves, according to the identified changes in representation of land cover types with an increasing degree of urbanisation. The most urgent future challenge identified is to develop urban nature conservation strategies that are integrated into the urban context including other green areas and built-up areas, the land-use history, and the requirements for local ecosystem services across the landscape.

Fragmented structures and vertical control systems

PurposeThe purpose of this paper is to discuss the problem of management systems in human services dealing with children and young people not supporting efficient resource utilization, as well as how to deal with this problem.Design/methodology/approachThis paper is based on six years (2002‐2007) of research into human service organizations with regard to social activities focusing on children and adolescents. The authors conducted this research in collaboration with representatives of social services, health services, schools and pre‐schools in three municipalities in southern Sweden (2002‐2005) and four municipalities and two county councils (2005‐2007) in different parts of Sweden. The researchers met these representatives at seminars held every month. The seminars primarily served the purpose of discussing problems and opportunities, as well as allowing experiences to be exchanged between the representatives.FindingsThe circumstances of dependency between social services, schools and pre‐schools are obviously given in their inter‐relationships. Efficient resource utilization thus presupposes resources being distributed on the basis of transverse dialogues held between different actors. The organisational structure and management control systems should therefore be designed so that they support meetings and dialogues between actors involved in different activities and on different levels in social services, schools and pre‐schools.Originality/valueThis paper shows that dialogue across boundaries will provide the prerequisites for the knowledge‐ and experience‐sharing that is necessary to bring about efficient resource utilization in human services directed towards children and young people. Some proposals regarding a more effective and ethically legitimate utilization of resources are also made.

Regulated childhood: equivalence with variation

The overriding aim of this article is to make a contribution to the discussion on individual development plans (IDPs) in Sweden as an expression of a regulated childhood and institutional practice. Individual development plans are seen as a phenomenon linked to the emergence of an auditing society. In sum, children are studied as subjects in relation to content, form and assessment in the individual development plans. The IDP material was collected in October 2006 in three urban municipalities and one rural municipality in southern Sweden. The three urban municipalities comprised municipal areas that were ethnically relatively homogenous and heterogenous, respectively. The data consist of 82 randomly chosen plans for children in preschool and preschool classes, and the method is based on textual analysis. An overall picture of a multicontextual regulation of childhood and institutional practice gradually emerges. The analysis can be summarized in distinctive principal tracks, or normalities, marked by equivalence with variation

Individuella utvecklingsplaner för yngre barn i Sverige; Ett kritiskt ämnesdidaktiskt perspektiv

Individual development plans for younger children from a critical subject didactics perspective. The paper aims to describe and problematize the content of individual development plans (IDP) for preschool and preschool class (age six) pupils from a critical subject didactics perspective. The didactical 'what question' pertaining to content (the object of learning) is central to the analysis. Subject refers to the construction of content and not only in the narrow sense of academic subject, but also thematically and pragmatically connected across subject lines to the content of child care, upbringing and children’s possible questions. Critical didactics are applied to shed light on the relationships between the actors (children and teacher) and their co-determination and agency. The critical approach also encompasses study of the content in relation to the power dimensions of place, age, gender and ethnicity. IDP material was collected in October 2006 in four municipalities in southern Sweden, three urban and one rural. Both relatively ethnically homogeneous and heterogeneous districts were included in the three urban municipalities. The material comprised 82 randomly selected plans. The analysis can be summed up in three distinguishing main tracks or normalities: Academic subject-regulated normal children – in a relatively homogeneous urban district; Socially and monolingually regulated multicultural children – in a relatively heterogeneous urban district; Primarily needs-regulated monocultural children – in a rural municipality

Coping With Troublesome Clients in Home Care

I describe methods used by home carers to cope with troublesome clients and analyze how the organizational context affects their use. Empirical data consist of participant observation and field interviews with 14 home carers in three municipalities in southern Sweden. Home carers might try to avoid working with troublesome clients, prepare themselves mentally before visiting them, try to withhold them psychologically, try to understand them and explain their behavior, try to change their behavior, and vent experiences with colleagues. Although some of these methods are practiced frontstage, in interactions with clients, others take place backstage, only involving staff. Their use is influenced both by properties of frontstage work, for instance, the intimate nature of many tasks and the experienced need to keep up a "good" relationship with clients, and by the organization of backstage work, for instance, the organization of staff meetings and supervisors' understanding of coping processes.