Municipalities In Southern Sweden Research Articles

Experiences of managers and staff working in community-based mental health with people ageing with severe mental health problems.

Existing research shows that older people with severe mental health problems need different forms of support in daily life and in the community to lead an active and meaningful life. A common form of support for people with severe mental health problems in Sweden is attendance at community-based day centres (DCs). However, knowledge of staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs is scarce. The aim was to explore DC staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs during the retirement process. Telephone interviews were conducted with managers in 27 municipalities in southern Sweden. In addition, focus groups were held with personnel from a total of nine different DCs. The material was analysed using content analysis. The results showed that older people who receive support in community-based mental health care were viewed as a neglected group with complex needs, and the informants (managers and staff) had few policies to guide them when providing support. This made the informants desire more knowledge about best practices to support the target group. One theme emerged, Minding the gap between ideal and reality while working with a neglected group with complex needs, with three categories: Reasoning around unmet needs, Navigating in a muddled organisation, and Wishing for an enriched service. Together with previous research, the results can contribute to increase awareness about an overlooked group at risk of being neglected and the pitfalls that impact the possibility to guide this target group in their recovery journey. Further research focusing on the target group's own experience of their everyday life situations is also needed.

Identifying proactive and reactive policy entrepreneurs in collaborative networks in flood risk management

A policy entrepreneur is a distinct political actor aiming to affect change. The theoretical narrative regarding policy entrepreneurs is underpinned by their commitment to a policy solution, the multi-dimensional strategies they use to promote that solution, and a suite of attributes and skills facilitating their actions. Policy entrepreneurs reveal themselves through their attempts to transform policy ideas into policy innovations and, hence, disrupt status quo policy arrangements. Indeed, policy entrepreneurs share sensibilities with entrepreneurs in the market, whose conceptualisation serves as a heuristic for their counterparts in policy and politics. The emphasis on change borne out of innovative solutions distinguishes policy entrepreneurs from many other actors who aim to maintain current institutional settings and power relations. The growing scholarship on policy entrepreneurship assumes intentionality as inherent to the policy entrepreneur and their actions, foregrounding the image of the tenacious political actor set on steering their a priori pet policy to a suitable problem. This article draws from the market theory on entrepreneurship, contrasting proactive policy entrepreneurship (entrepreneurship by opportunity) and reactive policy entrepreneurship (entrepreneurship by necessity). We conduct a comparative social network analysis of three municipalities in southern Sweden focused on flood risk mitigation. We demonstrate two different logics of policy entrepreneurship (as a result of seizing opportunities versus as a reaction to vertical pressure), and we explore the consequences for enhancing our understanding of policy entrepreneurship.

Growing Inwards: Densification and Ecosystem Services in Comprehensive Plans from Three Municipalities in Southern Sweden

This article analyses how urban densification, primarily in relation to ecosystem services, is addressed in comprehensive plans from three cities in southernmost Sweden: Malmö, Lund and Helsingborg. The aim was to investigate and problematise how the comprehensive plans articulate and negotiate how to build dense cities while preserving and enhancing ecosystem services. A qualitative content analysis was performed on the comprehensive plans in use during the study period. The comprehensive plans were all ambitiously formulated. However, three recurrent issues were found. Planners struggled to address the issue of scale: Ecosystem services in the city were addressed when planning for densification, while ecosystem services for the city were either omitted or mentioned in the passing. The timeframe in relation to sustainable urban development was also not clarified. Most importantly, there were profound unclarities regarding priorities. Densification was suggested to provide all positive qualities simultaneously, including enhancing and supporting ecosystem services, which is, from a systems viewpoint, not possible. We suggest that when planning for sustainable cities, based on best available research, politicians should bring the prioritisation process to the fore, to clarify and address how to plan for dense, healthy cities with functioning ecosystem services in a more holistic manner.

The challenge of risk prevention in home healthcare-An interview study with nurses in municipal care.

Safety in home healthcare has garnered increased attention as more people are receiving care for complex conditions at home. The prerequisites for providing safe care at home differ from those in hospitals. Malnutrition, falls, pressure ulcers and inappropriate medication commonly follow poor risk assessments, causing unnecessary suffering and costs. Therefore, risk prevention in home healthcare needs to be prioritised and studied more closely. To describe nurses' experiences of performing risk prevention in municipal home healthcare. Qualitative inductive approach, using semi-structured interviews with 10 registered nurses in a municipality in southern Sweden. Data underwent qualitative content analysis. The analysis resulted in three main categories and one overarching theme describing nurses' experiences of risk prevention in home healthcare. Getting everyone onboard comprises the categories: Managing safety while respecting the patient's self-determination, which covers patient participation, the strategic importance of respecting different views of risks and information and the fact that healthcare workers are guestsin the patient's home. Finding ways to make it work touches upon the relational aspect, including next-of-kin and promoting a common understanding to prevent risks. Being squeezed between resources and requirements refers to ethical dilemmas, teamwork, leadership and organisational prerequisites. Patient habits, living conditions and limited awareness of risks is a challenge in risk prevention in home healthcare, where patient participation plays a pivotal role. Risk prevention in home healthcare needs to be initiated at an early stage of disease and ageing and should be seen as a process where early health-promoting interventions can prevent the development and accumulation of risks over time. Long-term cross-organisational collaborations and patients' physical, mental and psychosocial conditions also need to be taken into account.

Physical Activity Levels, Perceived Body Appearance, and Body Functioning in Relation to Perceived Wellbeing Among Adolescents.

This study aimed to investigate self-reported physical activity levels, perceived body appearance, and body functioning in relation to perceived wellbeing among adolescents. A cross-sectional survey was performed in four upper secondary schools in one municipality in southern Sweden. Data were obtained from questionnaires completed by 1,491 adolescents (55.4% females; median age 16; range 15–17 years) during school hours. The participation rate was 71.4%. Logistic regression analyses were carried out with wellbeing as the dependent variable. The independent variables included gender, perceived family financial situation, perceived body appearance, perceived body function, and physical activity level. Perceived positive wellbeing was associated with being satisfied with their body's appearance (OR 3.4; CI 2.6–4.4) and function (OR 3.1; CI 2.2–4.2), being physically active three or more times per week (OR 1.5; CI 1.1–2.0), and a good perceived family financial situation (OR 3.3; CI 1.6–6.7). Gender was not significantly associated with wellbeing. A positive body image, which include both body appearance and body function, and high physical activity levels were significantly associated with wellbeing in adolescents, corroborating the importance of promoting physical activity among younger populations.

Does gender matter? The association between different digital media activities and adolescent well-being

BackgroundPrevious research on the relationship between social media use and well-being in adolescents has yielded inconsistent results. We addressed this issue by examining the association between various digital media activities, including a new and differentiated measure of social media use, and well-being (internalizing symptoms) in adolescent boys and girls.MethodThe sample was drawn from the four cross-sectional surveys from the Öckerö project (2016–2019) in eight municipalities in southern Sweden, consisting of 3957 adolescents in year 7 of compulsory education, aged 12–13. We measured the following digital media activities: playing games and three different activities of social media use (chatting, online sociability, and self-presentation). Our outcome measure was internalizing symptoms. Hypotheses were tested with linear regression analysis.ResultsSocial media use and playing games were positively associated with internalizing symptoms. The effect of social media use was conditional on gender, indicating that social media use was only associated with internalizing symptoms for girls. Of the social media activities, only chatting and self-presentation (posting information about themselves) were positively associated with internalizing symptoms. Self-presentation was associated with internalizing symptoms only for girls.ConclusionOur study shows the importance of research going beyond studying the time spent on social media to examine how different kinds of social media activities are associated with well-being. Consistent with research in psychology, our results suggest that young girls posting information about themselves (i.e. self-presentation) might be especially vulnerable to display internalizing symptoms.

Prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes: A focus group study with nurse aides, registered nurses and managers.

Background: Despite available knowledge how to prevent the risk of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes, these risks still frequently occur and cause a major burden for older persons; furthermore, for the health care system, they are extremely costly. One way to combat these risks is to register the prevention process in quality registries. However, the increasing older population worldwide is going to put high demands on those working with this group of people. Objective: To explore how nurse aides, registered nurses and managers in nursing homes experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in general and according to the quality register Senior Alert care process. Methods: A qualitative study was conducted in nursing homes in a municipality in southern Sweden. We purposively sampled nurse aides, registered nurses and managers (n=21) working in nursing homes registered in the quality register Senior Alert, who then participated in one of five focus group semistructured digital interviews held between February and April 2020. The interviews were audio recorded. Data were analysed using reflexive thematic analysis. Results: Our findings explore how nurse aides, registered nurses and managers experience working with the prevention of pressure ulcers, malnutrition, poor oral health and falls in nursing homes both in general and according to Senior Alert. The following four themes were generated during the analysis: (1) is included in the everyday work, (2) requires team effort, (3) requires handling many challenges and (4) requires finding strategies. Conclusion: The prevention of pressure ulcers, malnutrition, poor oral health and falls among older persons in nursing homes is complex. There is a commitment and responsibility among nurse aides, registered nurses and managers regarding preventive work and team effort, and finding useful strategies is necessary for the work to be successful. However, challenges, both at the individual and organizational levels, are involved, which implies that smoother organizational routines facilitating this preventive work are needed. Although nurse aides, registered nurses and managers are good at finding strategies that facilitate this work, one of the main challenges seems to lie in the variety of knowledge found among those working in nursing homes, particularly among nurse aides. This challenge was voiced by all the professionals, which suggests the need for a tailored educational intervention aimed at increasing the related knowledge among those working in nursing homes to enhance preventive work.

Subjective Health, Physical Activity, Body Image and School Wellbeing among Adolescents in South of Sweden.

This study aimed to investigate subjective health and its associations with perceived body image (body appearance and body functioning), physical activity, perceived wellbeing in school, perceived family financial situation, and body mass index among 13- to 15-year-old boys and girls. The study was a cross-sectional study performed in four municipalities in Southern Sweden. Data were obtained from questionnaires completed by adolescents (median age 14; range: 13–15) in Sweden (n = 1518, 51% girls), with a participation rate of 73%. Body weight and body height were measured by school nurses and body mass index was calculated. Logistic regression analyses were carried out with subjective health as the dependent variable. Independent variables included in the model were perceived wellbeing in school, perceived family financial situation, perceived body image, physical activity, body mass index, sex, and residency. Variables significantly associated with good subjective health were good wellbeing in school, a perceived good family financial situation, perceived positive body appearance, perceived positive body functioning, being a boy, and high physical activity. Residency and body mass index were not associated with subjective health. Good subjective health is associated with good wellbeing in school, good family financial situation, positive body image, and high physical activity levels. The results highlight the importance of good school climates, the promotion of positive body image, and increased physical activity for adolescents.

Alcohol drinking among adolescents with native-Swedish and non-European immigrant background: the importance of parental attitudes and peer attitudes for acculturation

In this study, we examine differences in alcohol drinking between first- and second-generation non-European immigrant and native-Swedish adolescents. We also examine whether parental and peer attitudes toward alcohol are associated with the acculturation of drinking habits among adolescents with an immigrant background. The study is cross-sectional and based on a school survey conducted in 2016–2019 in eight municipalities in southern Sweden. The sample consists of 3743 adolescents in year 9 of compulsory education, aged 14–15 years, of which 538 (14.4%) had a non-European immigrant background. Non-European immigrant adolescents reported significantly lower levels of drinking than native-Swedish adolescents. Second-generation immigrants reported a higher level of consumption than first-generation immigrants, and among first-generation adolescents, drinking was more prevalent the longer the adolescents had resided in Sweden, which suggests acculturation of drinking habits. This acculturation is mainly related to changes in peer attitudes toward alcohol. Immigrant adolescents with a longer stay in Sweden reported having friends with more positive attitudes toward alcohol. Among first-generation immigrants, drinking was more common among boys than girls. These differences were primarily found among immigrant adolescents with a relatively short period of residence in Sweden, which suggests that acculturation occurs more quickly among boys than among girls.

Internet use and adolescent drinking: Does it matter what young people do online?

BackgroundIn this study we examine whether the association between internet use and drinking could be different for different types of internet activities among adolescents. We also adjust for a number of theoretically relevant factors such as peer influence, unstructured activities, impulsivity and parental monitoring. MethodThe data are drawn from four cross-sectional surveys from the years 2016–2019 in eight municipalities in southern Sweden. The sample consist of 3733 adolescents in year 9 of compulsory education, aged 14–15. ResultsThe results show that there is an association between internet activities and drinking and that there are differences depending on what young people do online. Self-presentation and online sociality are both positively associated with drinking, whereas news consumption and playing games are negatively associated with drinking. The results also show that the association between the different internet activities and drinking becomes weaker when adjusting for the control variables. ConclusionThis study suggests that more research is needed to examine the correlations between different forms of internet activities and drinking among adolescents in more detail.

Social Jetlag and Its Association With Screen Time and Nighttime Texting Among Adolescents in Sweden: A Cross-Sectional Study.

The discrepancy between social and biological clock due to sleep and wake up time difference across weekdays and weekends is referred as social jetlag. The overall aim of this study is to test whether there is an association between both screen time and nighttime texting and social jetlag among 13- to 15-year-old adolescents in Sweden. This study included a cross-sectional survey in which data were collected from all schools with grades 7 and 8 in four municipalities in southern Sweden. The sample consisted of 1518 students (72.7% response rate), among whom 50.7% were girls. Ages varied between 13 and 15 years (mean, 13.9; standard deviation (SD), 0.4). Social jetlag was defined as more than 2 h difference between bedtime and wake-up time on school days compared to weekends. The prevalence of social jetlag among this study population was 53.9%. After adjusting for age, sex, and economic status, the multivariate binary logistic regression analysis results showed that increased screen time (p < 0.001) and texting at night (p = 0.002) were significantly associated with social jetlag. Irregular bedtime and wake-up habits on school days and weekends are associated with nighttime texting and increased screen time. For future research, more focus should be given to identifying causality factors and gain an understanding of the effects of social jetlag, which will help in developing appropriate public health messages and intervention programs.

Strategies, Processes, and Results for the Future Water Supply of the Växjö Municipality Evaluation of an Evidence-Based Case Study of Long-Term Strategies within the Water and Wastewater Sector in Sweden

In 2009, the Bergaåsen Water Supply Scheme was put into operation to ensure the future drinking water supply of two municipalities in southern Sweden. Bergaåsen replaced two vulnerable water treatment plants. It was implemented in an environment that was characterized by sensitive recipients and limited access to water. This article aims to analyze how strategies were developed to meet sustainability requirements, if this solution has ensured good quantity and high quality after ten years of operation, and the extent of the project’s economic impact on consumers. The project was analyzed as an evidence-based case study using semi-structured interviews, surveys, and document analyses. The study found that the chosen options succeeded in guaranteeing outstanding quality and secure delivery. Over 90% of water users were satisfied and had trust in it, and less than 3% were dissatisfied. The design time for withdrawal capacity has been extended from 30 to 50 years through planned measures. The study clarifies also that, due to some externalities, there has been virtually no economic impact on users. Bergaåsen is a clear case for the value of developing long-term strategies and implementing them in real life.

Housing plans of the oldest: ageing in semi-rural areas in Sweden

A number of smaller municipalities have decreasing population rates. Generally, the young move out, increasing the proportion of older people. To increase our understanding of the living conditions of an ageing population in small municipalities, a postal survey was conducted in three small, semi-rural municipalities in southern Sweden. In the survey the respondents answered questions about their living situation and their housing plans. The aim of this study was to investigate the housing situation and housing plans of the very old in semi-rural areas and research questions analysed for this study concerned the current housing situation and plans for future housing. A total of 1386 surveys were sent out in March 2014, to all inhabitants aged 80 years or more, residing in the ordinary housing market in the three municipalities, the response rate was 60%. The results show that most of the respondents were firmly rooted in the area as most of them had lived in the municipality for more than 20 years and 60% had lived in their current dwelling for more than 20 years. Ageing in place was the dominating plan, although one quarter of the respondents answered that they did not know what would happen in the future. Those who planned to move wanted to move to housing that required less maintenance and to a more central location. Residential mobility is at play also in old age as 27% of the respondents had moved at some point during the last 10 years, i.e., after the age of 70.

Place satisfaction revisited: residents’ perceptions of “a good place to live”

PurposeUsing service-based logic as its theoretical lens, this study aims to approach residents’ place satisfaction in a novel way. The purpose is to explore residents’ perception of the place in which they live and to shed new light on their place satisfaction.Design/methodology/approachThe paper is based on explorative qualitative focus group research. Data were collected in two typical municipalities in southern Sweden. The sampling procedure was purposive, resulting in six focus groups, consisting of a total of 33 residents. The empirical material was transcribed and analyzed using a structured content analysis inspired by grounded theory.FindingsA model for understanding residents’ perceptions of what constitutes a good place to live is introduced. The model shows that many value propositions are produced in the provider sphere, independent of the user, for example by the municipality or the business sector. Other value propositions are co-created in a joint sphere, meaning that the user is actively involved in the production of these value propositions. The resident then uses different value propositions to create value-in-use in the resident sphere, independent of the provider, and to co-create value-in-use in the joint sphere.Originality/valueThe study creates a bridge between the stream of research on place satisfaction and studies that take stakeholders and co-creation into consideration; it shifts from the prevalent provider perspective on place branding and static place attributes to a focus on the relationship between users and providers.

What about community sustainability? – dilemmas of ageing in shrinking semi-rural areas in Sweden

ABSTRACTMany municipalities in Sweden have decreasing population rates combined with an increasing proportion of older people. Such a demographic shift will influence the way life is led as the foundation for service provision and social activities becomes undermined. This leads us to question the extent to which shrinking municipalities can be considered socially sustainable. The aim of the paper was to investigate older people’s participation in the local community and to study the perceived changes in the local community as reported by older people and how these are experienced. A postal survey was sent out to all inhabitants aged 80 years and older living in their own household in three small, semi-rural municipalities in southern Sweden, in total 1386. The response rate was 60%. Thus, focus was on the experiences of the oldest individuals. The research questions analysed for this study concerned the ageing population’s social networks, community involvement, car dependence and service provision. The results are used to discuss the social sustainability of the societies in which these people have lived for a long time.

Experiences of cancer rehabilitation: A cross-sectional study.

To investigate the cancer rehabilitation experiences of working-age cancer survivors. Cancer survivors have extremely complex needs, spanning physical, vocational and sexual domains. Although cancer rehabilitation services have been found to eliminate or reduce these strains, these services are often underutilised. A cross-sectional study design was employed. A survey of persons over the age of 18 with a cancer diagnosis, enrolled in the Social Insurance Agency in a municipality in southern Sweden (n=168, 68% women), was conducted. Patients who used the cancer rehabilitation service (57%) were generally satisfied with it. Of participants, 26% reported not having received an offer of rehabilitation. Of those who reported that they received information about cancer rehabilitation services, most also reported that they received this information from a healthcare service professional (69%); for example, from the oncology nurse or the oncologist, whereas 20% claimed they received the information from the administrator of the Swedish Social Insurance Agency. A minority of children and family members of patients received support from the healthcare system. More efforts should be taken to reach patients in need of cancer rehabilitation. Additionally, more attention should be directed towards family members and young children. More than one in four patients claimed to not have received an offer of cancer rehabilitation, and an even greater number of patients claimed that their spouses and children had never received an offer for this service either. Hence, there is a communication barrier that needs to be overcome. Health providers should be aware that information needs to be repeated several times, and presented both orally and in writing.

The Southern Sweden Adolescent Allergy-Cohort: Prevalence of allergic diseases and cross-sectional associations with individual and social factors

ABSTRACTObjectives: Asthma and allergic diseases are the most frequent chronic diseases in childhood worldwide, and considered a burden for the affected children and their families. The diseases impose an economic burden on society if not diagnosed and treated properly and management of and these diseases are challenging for healthcare professionals. The aim of the present investigation was to assess the prevalence of allergic diseases in an unselected cohort of adolescents in southern Sweden. Additionally, associations with sociodemographic factors were investigated, as well as impact on daily life. Methods: This cross-sectional study was based on a cohort of n = 1 530 school children, aged 13 to 14, from 13 municipalities in southern Sweden. Data were collected through web-based questionnaires. Results: Of all children 32% reported at least one allergic disease. 67% reported one allergic disease and 33% reported more than one. No allergy-related disease were reported by 68%. Current asthma was reported by 9.8% and current rhino-conjunctivitis was reported by 13%. The prevalence of food hypersensitivity was 12% and the prevalence of eczema was 11%. One to three wheezing attacks were reported from 55% and 40% reported more than four attacks of wheezing in the preceding year. The self-reported allergic diseases were diagnosed by a doctor in; 36% (food hypersensitivity) to 69% (rhinoconjunctivitis) of the cases. Conclusions: A high number of affected children were identified. Some children being undiagnosed and some not receiving satisfactory treatment. These results suggest that additional studies to evaluate treatment procedures in order to improve healthcare for allergic children are warranted.

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.