Grönskans plats vid förtätning

I den här uppsatsen studeras grönområden i miljonprogramsområden och deras ursprungliga idé samt hur de påverkas av senare förtätning. Med miljonprogram avses byggandet mellan åren 1965 och 1974 med målet att uppföra en miljon bostäder på tio år. Områdena påverkas idag i hög utsträckning av ytterligare bostadsbyggande. Arbetet avslutas med ett gestaltningsförslag och har följande frågeställningar: “Hur förändras utemiljöns rum och upplevda skala av miljonprogrammets förtätning?” och “Hur kan ett grönstråk vid miljonprogramsområdet Bandstolsvägen i Uppsala gestaltas till ett mer sammanhängande stråk med ökade rumsliga och estetiska kvalitéer?”. Uppsatsens syfte är att undersöka miljonprogrammens pågående förtätning med fokus på grönskans plats i förtätningsprojekt samt hur befintliga rumsliga kvalitéer kan lyftas. Genom fältbesök och därefter en för den här uppsatsen skapad rumslig analysmodell studeras områdenas stadsmorfologi, grönstruktur och skala. Genomgången visar att grönområden ofta används vid förtätning. Värden som riskerar att gå förlorade vid förtätning är: träd som medlare i skala, vy över vegetation från bostaden, grönska mellan hus, ljusinsläpp på gårdar och i bostäder, rymd i utemiljö och mellan hus, rum för gående avskilt från bilar samt länken till grönområden och bostadsnära natur. Mot bakgrund av fältbesöken och den rumsliga analysen ges ett förslag på gestaltning av ett grönstråk i miljonprogrammet vid Bandstolsvägen i Gottsundaområdet, sydväst om Uppsala centrum. Gestaltningen fokuserar på hur den gröna ytan kan bevaras och utvecklas genom fler sociotopvärden. Den fördjupade studien av området syftar till att visa grönområdenas potential i miljonprogramsområden och hur förändring i enlighet med mänsklig skala kan göras. I fördjupningen används Uppsala kommuns planprogram för Gottsundaområdet och intervju med två projektledare vid kommunen. I den fördjupade studien genomfördes vidare upprepade fältbesök för att se platsen under olika tider på dygnet, väder och årstider som ett viktigt verktyg för den rumsliga analysen och en platsspecifik gestaltning. Gestaltningsarbetet vill visa potentialen i de grönområden som ofta beskrivs som ”restytor” och därför i hög utsträckning exploateras. Vi vill också visa hur fokus kan skiftas till att rusta upp och höja befintliga kvalitéer istället för att ta bort och göra nytt. Redan rumsskapande element och vegetation kan bevaras och utnyttjas för att skapa distans mellan privat och offentligt eller skapa fokuspunkter och riktningar. I vår gestaltning har den befintliga vegetationen sedan kompletterats med sociotopvärden i form av ytor för lek och umgänge i bostadsnära natur samt dekorativ grönska.This paper focuses on how green spaces were originally created in areas built within the Swedish Million Programme during 1965–1974 and how these areas are highly affected by additional residential construction today. The paper answers the following research questions: “How does the space and perceived scale of the outdoor environment change as a result of the densification of the Million Programme areas?” and “How can a green wedge in the Bandstolsvägen area in Uppsala be redesigned into a more coherent park trail with increased spatial and aesthetic qualities?”. The paper concludes with a design proposal. We study the urban morphology, green space and scale of the areas through field visits and follow a spatial analysis model created for the essay. The study shows that green spaces are often used in densification. We also find that the following values are at risk of being lost in densification: trees as mediators of scale, views of vegetation from dwellings, greenery between buildings, light in and around houses, space in the outdoor environment and between buildings, pedestrian spaces separated from cars and links to green spaces or nearby natural environments. Against the background of the field visits and the spatial analysis, a proposal is made for the design of a green wedge in the million programme at Bandstolsvägen in Gottsunda, southwest of Uppsala city centre. We use the Uppsala municipality's planning programme for the Gottsunda area and an interview with two project managers at the municipality. Repeated field visits were carried out to see the site at different times of the day, weather and seasons. The design demonstrates the potential of green spaces. These areas are otherwise often considered leftover areas and are therefore largely overlooked. We show how the focus should shift to restoring and enhancing existing qualities rather than removing and making new ones from scratch. Existing spatial elements and vegetation can be preserved and used to create distance between private and public space or to create focal points and directions. Further, the existing vegetation is complemented with sociotope values in terms of spaces for recreational and social activities in residential areas and decorative greenery

Participation in screening for breast and cervical cancer among women with current or previous drug use : a survey study

Background: Women with current or previous drug use (WCPDU) have an increased risk of poor breast and cervical cancer outcomes. Screening is known to decrease the mortality of these common cancer forms, but screening participation has been sparsely investigated among women with drug dependency. The aim of this study was to assess participation in screening for breast and cervical cancer among WCPDU. Methods: We recruited WCPDU to a survey study, from six opioid substitution treatment (OST) clinics and one needle exchange program (NEP) in Malmö, Sweden, and through the Drug Users Union in Stockholm, Sweden. The survey was constructed according to results from focus group discussions about cancer screening in a sample of women in OST. Survey data were analyzed using descriptive statistics. We analyzed associations between non-compliance to screening and healthcare contact (OST, NEP or none) by logistic regression analysis; unadjusted and adjusted for age, native language, housing situation, educational attainment and main source of income. Results: A total of 298 women (median age 43 years) responded to the survey. The self-reported compliance with cancer screening recommendations was 29% for breast cancer screening and 41% for cervical cancer screening. Non-compliance with cervical cancer screening was associated with NEP participation in univariate but not multivariate analysis. We did not find an association between non-compliance with breast cancer screening and healthcare contact. Non-compliance with screening for cervical cancer was also associated with unstable housing in univariate and multivariate analyses, and inversely associated with increasing age in a univariate analysis. Non-compliance with breast cancer was associated with unstable housing in a univariate analysis, and inversely associated with not having Swedish as a native language in a multivariate analysis. Conclusion: The self-reported compliance with the national cancer screening programs for breast cancer and cervical cancer of WCPDU is notably lower than in the Swedish general population. Women with unstable housing seem to be particularly vulnerable to non-compliance with cancer screening. Interventions to minimize barriers to cancer screening are crucial to decrease the increased cancer morbidity and mortality among WCPDU

Female Swedish backpackers in Vietnam: A hypotheses generating study on sexual health risks while travelling.

BACKGROUND: According to previous studies, foreign travellers and backpackers are at increased risk of sexually transmitted infections (STI). Concurrently, STI incidence, especially Chlamydia, is increasing among young Swedes. Our objective was to investigate Swedish backpackers' own view of sexual health and risks while travelling, with the purpose to identify hypotheses for further, more extensive research. METHOD: In-depth semi-structured interviews were carried out in Vietnam with four Swedish women in their early twenties. The interviewees had been travelling throughout South East Asia for a period of at least two weeks. RESULTS: There were large differences between the respondents regarding perceived health risks in relation to food safety, STI, and alcohol and drug use; and to what extent their behaviour while travelling deviated from their normal one. In contrast, the interviewees shared a perceived lack of knowledge about sexual health abroad. CONCLUSIONS: The study identified six hypotheses and suggestions for preventive measures that could be analysed in future research. The study demonstrated that sexual behaviour as well as attitudes and norms were strongly linked to the individual level, rather than to the group of backpackers

Perceived healthcare stigma among patients in opioid substitution treatment : a qualitative study

Background: People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them. Methods: Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach. Results: Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history. Conclusion: This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff

Screening for breast and cervical cancer among OST patients : a qualitative study of barriers and suggested interventions to increase participation

PURPOSE: Women with current or previous drug use are at risk of poor breast and cervical cancer outcomes. While screening is known to decrease cancer mortality, screening participation is sparsely investigated among drug dependent women. The aim of this study was to explore experiences of breast and cervical cancer screening-including barriers and suggested interventions to promote increased participation-among women in opioid substitution treatment (OST). METHODS: Three focus group interviews were conducted at one OST clinic in Malmö, Sweden. The interviews were moderated by OST staff, assisted by a researcher. A descriptive qualitative analysis was carried out using a template analysis approach, employing a model of healthcare access to organize the description of barriers. RESULTS: The 11 participants reported several barriers to screening access, affecting the perceived need of screening and the opportunities to seek and reach screening services. Some barriers appear to be specific to women with previous or current drug use. Suggested interventions were moral and practical support, integrated/specialized delivery of screening services, and enhanced screening invitation procedures. CONCLUSIONS: The study findings provide insight to difficulties with screening compliance among women with current or previous drug use, and provide a knowledge base for quantitative and intervention studies

Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment

Background. Individuals with opioid dependence are at increased risk of deteriorating health due to the lifestyle connected to heroin use. Barriers surrounding the healthcare system seem to hinder patients to seek help through conventional healthcare, even after entering opioid substitution treatment (OST), resulting in a high level of unmet healthcare needs. However, this field is still unexplored, with only a few studies focusing on general health within this population. The first step, in order to provide suitable and accessible primary healthcare, is to assess the extent of physical symptoms and unmet healthcare needs within the OST population, which, to this point, has been sparsely studied. Aim. To assess OST patients’ self-rated physical health and healthcare seeking behaviour. Methods. Two-hundred and eighteen patients from four different OST sites answered a questionnaire regarding physical health and healthcare seeking. Results. Patients in OST have a high degree of physical symptoms and a high degree of unmet healthcare needs. Sixty-six percent reported suffering from musculoskeletal pain. Fifty-six percent reported gastrointestinal symptoms. Genital problems and airway symptoms were reported by 47%, respectively, and dental problems were reported by 69% of the respondents. General unmet healthcare needs were reported by 82%. Musculoskeletal pain was positively correlated with having an unstable housing situation (AOR 4.26 [95% CI 1.73-10.48]), negatively correlated with male sex (AOR 0.45 [95% CI 0.22-0.91]), and positively correlated with age (AOR 1.04 [95% CI 1.01-1.07]). No statistically significant correlates of respiratory, gastrointestinal, genital, or dental symptoms were found. Conclusion. Patients in OST carry a heavy burden of physical symptoms and unmet healthcare needs, potentially due to societal barriers. Patients’ frequent visits to the OST clinics offer a unique opportunity to build a base for easily accessible on-site primary healthcare

Health Literacy among Swedish Patients in Opioid Substitution Treatment : A Mixed-Methods Study

Background: Poor health and unmet healthcare needs is common among people with substance use disorder (SUD) including patients in opioid substitution treatment (OST). Low health literacy (HL) is associated with poverty, low education and physical limitations, but is unexplored in an OST context. Methods: Mixed-methods were used. Participants were consecutively recruited by clinic staff or researcher, from five OST clinics in Malmö, Sweden, during September – November 2019. HL level was measured through HLS-EU-Q16 (n?=?286). Self-reported socioeconomic correlates of HL were analyzed through logistic regression. Patients’ experiences of HL-related problems were assessed through six focus group interviews (n?=?23) moderated by an OST employee. Results: While 46% had sufficient HL (13–16 points of maximum 16), 32% did not receive a HL score due to too many missing answers. No correlates of sufficient HL level were found. Missing HL level was associated with low educational attainment (Ajusted odds ratio [AOR] 1.94; 95% Confidence interval [CI] 1.13–3.32) and negatively associated with employment (AOR 0.28; 95% CI 0.11–0.71). Qualitative data revealed a diversity in participants’ self-assessed capabilities, and problems associated with access, comprehension, trust and dependency on addiction-specific services. Conclusions: This study highlights that HL level is low, and identifies a number of concrete problems related to HL in the studied population. The results implicate a need for tailored interventions regarding health information among OST patients

Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare

Background: Opioid substitution treatment (OST) populations are aging and have increased mortality and somatic morbidity compared to general populations internationally. While OST patients have poor self-rated physical health and unmet healthcare needs, documented healthcare utilization has been sparsely investigated. The aim of this study was to assess registered healthcare utilization for somatic conditions in a sample of Swedish OST patients, and compare healthcare utilization among OST patients with and without use of on-site primary healthcare (PHC). Methods: Patients in OST in Malmö, Sweden, were recruited for a survey study conducted in 2017–2018. Survey data were compared with comprehensive patient records from specialized and primary care during one year prior to study inclusion (total n = 190). All patient records were examined for healthcare utilization, source of healthcare (PHC, emergency care and secondary care), and documented diagnoses and symptoms. Factors associated with healthcare utilization were analyzed by using logistic regression analysis. Patients with and without on-site PHC were compared by using descriptive statistics and Chi-2 test. Results: A total of 88% of the sample had been in direct or indirect contact with somatic healthcare during one year (PHC 66%; emergency care 28%; secondary care 67%). The most prevalent somatic diagnoses were infectious diseases (39%) and symptom diagnoses (37%). Respiratory, dermatological and musculoskeletal diagnoses, and trauma/intoxication were documented in 21–26% of the sample, respectively. PHC utilization was associated with older age and being born in Sweden. Among patients with on-site PHC (n = 25), the number utilizing secondary care was 84%, and certain diagnostic codes were more frequent in this group. Conclusion: OST patients are seemingly underserved as regards their physical health. Since increased OST access decreases opioid overdose fatalities, the life expectancy among OST patients is likely to increase and thereby also increases the risk of age-related conditions. Thus, easily accessible physical healthcare is of great importance in this group. On-site PHC might be a way to establish healthcare contact with OST patients, especially for non-acute conditions, although further research is needed