Legg-Calvé-Perthes disease and the risk of injuries requiring hospitalization

Background and purpose Previous studies have suggested that Legg-Calvé-Perthes disease (LCPD) is associated with repetitive trauma, coagulation problems and anatomical abnormalities of the blood supply to the femoral head. The hypothesis that repetitive trauma can affect the blood supply of the femoral head, leading to LCPD, is supported by an animal model. For evidence of an increased risk of repetitive trauma, we investigated whether patients with LCPD have a higher risk for severe injuries requiring hospitalization. Patients and methods We identified 2579 patients with LCPD in Sweden during the period 1964-2005. 13,748 individuals without LCPD were randomly selected from the Swedish general population, matched by year of birth, sex and region (control group). Cox proportional hazard regression estimated the risks. Results Compared to the control group, patients with LCPD had a modestly raised hazard ratio (HR) of 1.2 (95% CI 1.1-1.3) for injury requiring hospitalization. The risks were slightly higher for soft tissue injuries (HR = 1.3, 95% CI:1.1-1.4) than for fractures (HR = 1.1, 95% CI: 1.0-1.3) and more pronounced among females. Compared to the control group, the higher risk for injury only applied to the lower extremities (HR = 1.2, 95% CI: 1.0-1.4) in patients with LCPD. Interpretation Patients with LCPD are vulnerable to injuries which could be interpreted as a marker of hyperactive behavior. It could also implicate that anatomical changes in the bone formation or blood supply of the femoral head - increasing its sensibility for trauma - contribute to the etiology of LCPD. © Copyright: ©Nordic Orthopaedic Federation

Scandinavian long-term care financing

In this paper, we compare and analyse the systems for financing long-term care for older people in the Scandinavian countries – Denmark, Norway and Sweden. The three countries share common political traditions of local autonomy and universalism, and these common roots are very apparent when the financing of long-term care is concerned. Nevertheless, the Scandinavian systems for long- term care (LTC) exhibit some important deviations from the idealized “universal welfare state” to which these countries are normally ascribed. For example, user charges tend to be strongly dependent on earnings, which is incoherent with the general norm of flat-rate public services. Also, there is significant regional variation in the level of services provided, which is in direct contrast with the universalist ambitions. Overall, the Scandinavian countries distinguish themselves through their very high reliance on public spending in long-term care. It is unclear to what extent the Scandinavian model for financing of long term care will be sustainable as demographic change progresses in the next few decades.long term care; financing; welfare state; Scandinavia

Private financing of elder care in Sweden. Arguments for and against

The idea that there is a need to increase the share of private financing of the costs of elder care is expressed by several actors attempting to influence the direction of social policy Sweden these days. This idea fundamentally challenges established ways of financing and organising delivery of elder care services in Sweden. Underlying proposals for increasing private financing is the claim that the future scope of public elder care provision must contract, both vertically and horizontally. Underlying this claim is the assumption that both the quantity and quality of services demanded will increase, while the supply of public funds cannot. Vertical contraction aims to draw new funds from users willing to pay more to get higher quality services. Horizontal contraction aims to reduce the scope of public sector’s responsibility in service provision. This paper outlines recent developments in private provision of elder care services and examines arguments and actors for increasing private financing. Although the proposals have been put forward by influential actors, opposition to increasing private financing has been expressed, and support for solidaristic funding of elder care remains strong. Accordingly, we also consider these dissenting arguments and actors. Our purpose is to set out and evaluate the arguments, evidence and interests behind the proposals, and the likely outcomes of their implementation.Elder care; Private financing; Social policy; Sweden;

Disparities in Social Assistance Receipt between Immigrants and Natives in Sweden

Social assistance receipt among immigrants in relation to receipt among natives in Sweden is investigated. A background of how the system is constructed is provided, statistical information reported, the literature surveyed and key results interpreted. Most out-payment for social assistance in Sweden refers to foreign born persons although the category makes up 14 percent of the population. While some part of the high costs can be attributed to needs to maintaining recent refugees, this is not the entire story. Immigrants tend to assimilate out of social assistance receipt. However, receipt continues to be higher than among in several characteristics identical natives many years after immigration among immigrants from not rich countries. The elevated probabilities of social assistance receipt among immigrants from not rich countries are mainly due to failures of integrating into the labor market at the destination.social assistance, immigrants, Sweden

Sweden: Combining childbearing and gender equality

Sweden is the forerunner of the Second Demographic Transition. Fertility trends have fluctuated greatly since the 1960s, and the 1990s showed both European-highest and lowest-ever-in-Sweden levels, while the cohort pattern has been relatively stable. Period fluctuations have been accompanied by a postponement of entering committed partnerships and parenthood as well as an increasing instability of family relationships. The awareness and the availability of effective contraceptives have been extensive since the mid-1970s, the year the liberal abortion law was introduced. Post-modern values are dominant in this highly secularized society, but ideal family size is among the highest in the European Union, and childlessness has remained at a relatively low level. Ethnic diversification has increased over time, with about one-fifth of the population having a ‘foreign background’ in the early 2000s. The level of female labor-force participation is the highest in Europe (although mothers of pre-schoolers often work part-time), and young women are just as highly educated as men. Family policies, based on the principle of equality across social groups and gender, seem to play an important role in keeping fertility relatively high. In combination with other factors, family policies also play a role in the fluctuations of fertility rates, as eligibility to parental-leave and benefits as well as the availability of public childcare are linked to parents’ labor-force attachment.childbearing, Europe, fertility, gender equality, Sweden

Technology, institutions and allocation of time in Swedish households 1920-1990

The modernisation of Swedish households during the twentieth century prompted a considerable productivity growth in household production, which reduced the time input for a fixed volume of routine household work by about 35 per cent 1920-1990. Much of that time was gradually transferred to the labour market, but no evidence can be found for an increase in leisure time. What has been termed a "Cowan paradox" appears in the Swedish data: the output of household services increased significantly with productivity-enhancing technical change. This was, however, the case only in households where small children constituted an impediment to labour market entry. Increased returns to market work induced women who did not face this restriction to allocate more time to the labour market from the mid-1940s. A set of new formal and informal institutions associated with the family eventually redefined the concept of "small children" and so shifted the position of homemaker from being a more or less permanent status of some women to a clearly temporary position of most women.Time allocation; labour supply; household technologies; family policy

Social Assistance in Sweden 1990-1995

Despite being a very hot subject in the public debate, the causes behind the increase in social assistance (SA) in the 1990s are relatively unknown. In this paper, I try to investigate if the increase is in part a result of an increase in the propensity to receive SA. Despite what is usually argued in the public debate, I find no evidence of a general increase in the mentioned propensity in Sweden during the period 1990 to 1995. But although there is no evidence of an increased propensity to receive SA, some behavioural changes seem to have occurred. First, I find evidence that the recipients may be subjected to tougher judgement criteria in 1995 than in the 1990, something that could mask a possible increase in the studied propensity in the empirical analysis. Second, the propensity to become a SA recipient has increased among people with university education. Thirdly the propensity to receive SA among young people seems to be lower in 1995 than in 1990 but this may be due to a tougher attitude shown by the authorities that is particularly affecting this group.Social assistance; propensity; social assistance stigma

From psychotherapist to supervisor

This study is a part of an ongoing research project examining group supervision in psychotherapy. The study was performed in a postgraduate training program for prospective supervisors. The two-year supervisor training program included theory seminars as well as group supervision of the prospective supervisor’s supervision of a trainee who had a patient in psychotherapy. The training program was based on psychoanalytic theory and the psychotherapy conducted was psychoanalytically oriented. Supervisees´ and supervisors´ experiences of the learning process, supervision format in group and supervisor styles were explored in semi-structured interviews. Both supervisees and supervisors emphasized the importance of a specific training program for psychotherapists who intend to work as supervisors. The didactic aspects of supervision were pointed out. The group format was experienced as particularly suitable for this training level. The “super-supervisor’s” style was important as a role model for the supervisors in training

Swedish State Politics Meets Experiences Among Relatives of Persons with Mental Disability

AbstractMental disability is one of the most serious health problems facing Europe today. The reform of psychiatric care in Sweden ha s passed much of the rehabilitation and daily care of these people on to their families/relatives. The aim of this article is to analyze how the psychiatric reform in Sweden affects everyday life experiences among close relatives of persons with mental disabilities. It is an explorative, descriptive study using inductive qualitative content analysis of 18 individual interviews with close relatives. In order to deepen the understanding of the relatives’ situation and the consequences of the psychiatry reform, the relatives’ statements are put in a dialogue with how problems are represented in documents that form the basis of the psychiatry reform. The result indicates that the reform of psychiatric care in Sweden has put the solution of problems on the relatives, but for the relatives there is still no consensus among the different care providers, county council, municipal and national social servi ces that are involved in treatment. The results further indicate that the relatives feel guilty about not providing enough support for the persons with mental disabilities, and they expressed a need for personal support; a need for better information, consistency throughout the caring process and professional therapy for themselves as well. Children of parents with mental disabilities express a need for assistance, opportunities for participation in care, and information about their parents’ illness. Even th ough there are a lot of bad experiences, all relatives could also relate to positive experiences, i.e. open dialogues, relevant information and timely care and support given by some hospital staff. We recommend that relatives’ experiences are taken seriously in further reforms of the psychiatric care and that relatives meet in different kinds of supportive networks