A refamilialized system? An analysis of recent developments of personal assistance in Sweden

The Swedish system of disability support is often praised for its comparably well-developed Personal Assistance (PA) scheme. PA is formally prescribed as a social right for disabled people with comprehensive support needs in the Act Concerning Support and Services to Persons with Certain Functional Impairments (LSS). In the decade following the introduction of LSS in 1994, the PA-scheme expanded steadily to accommodate the support needs of more and more disabled people. It is commonly believed that the expansion of PA has substantially boosted the agency of both disabled people and their relatives. This article critically discusses in what direction the Swedish system of disability support has moved in the past decade. Is the common image of a system moving towards an ever increasing defamilialization of disability support still accurate? Or are there signs of stagnation, or even reversal towards refamilialization? What are the possible consequences of the more recent developments for disabled people and their relatives in terms of agency and equality? These questions will be discussed with the help of an analysis of the regulatory framework of disability support, statistical data and findings from public reports

Youth perspective on outreach service: A safety net for at-risk youth in a municipality

At-risk youth often rely on different municipal services, such as child welfare services, social services and medical services. All of these services play an important role in preventing drug use and promoting well-being, following the health promoting principles in the Norwegian Public Health Act of 2012. While the goal is for these services to coordinate their actions, many youths fall through the cracks of the system. Some municipalities have developed outreach services aimed at helping these at-risk youth. This study gives insight into the relationship between the outreach service and the youths, and how the youths experience the outreach service as compared to other municipal services through individual interviews and focus groups. The findings demonstrate that the outreach service has legitimacy as a trustworthy service, emphasizing the importance of at-risk youth having trusting relationships with professionals. The outreach service also promotes the youth’s empowerment, which was contrasted to the deficit-focus the youths experienced with other services. The outreach service’s resource-orientation endorses the need for empowering-oriented approaches aimed at at-risk youths. The findings also show that the outreach service is able to aid the youths in navigating with the other services. We discuss the outreach service role as a “safety net” between disintegrated services in the municipal organization, enabled by their legitimacy as a trustworthy service and the empowering approach. The study illustrates the valuable role a service such as the outreach service can play, both for the individual at-risk youth and also on a structural level within a municipal organization.publishedVersio

Local drug prevention strategies through the eyes of policy makers and outreach social workers in Norway

More than half of the municipalities in Norway report drug misuse as the most important public health challenge. Following a whole‐of‐government tradition, the ambition is to achieve horizontal and vertical coordination between different policy areas to address complex problems, such as youth drug use, and avoid fragmented services. This study aims to offer new perspectives on how governmental structures shape local drug prevention. By including the perspective of both local policy makers and outreach social workers, we can come closer to understanding how local drug prevention transforms policy into practice. The study will thus explore how policy makers and outreach social workers describe the local drug prevention strategy and how the outreach social workers implement it in practice. An instrumental case study of one Norwegian municipality was used to investigate the structures for drug prevention in detail. Data were gathered through 14 interviews with public officials from the relevant policy areas and outreach social workers from a drug prevention outreach service. The data were analysed using a thematic framework analysis. This study demonstrated that the policy makers’ and outreach social workers’ descriptions of drug prevention highlighted the creation of good living conditions and promotion of protective factors surrounding at‐risk youths. This perspective may offer a broader approach to drug policy, which includes many policy areas. While collaboration was regarded as paramount, the policy makers described a “siloed” organisation that made it difficult to collaborate. The outreach social workers, however, indicated that they were able to navigate the “siloed” structures. We discuss the structural conditions surrounding outreach social workers that shape the implementation of policies, such as the resource perspective. The discussion shows that outreach social workers may act as a safety net for a potentially fragmented municipal structure for drug prevention.publishedVersio

Privacy, meetings and rejections - a qualitative study of everyday life among young persons with psychiatric disabilities

This study explores how young persons with psychiatric disabilities experience everyday life according to places, social relationships and activities, using semi-structured, in-depth interviews and site-maps. Qualitative content analysis was chosen for analyzing the interviews in comparison with information from the sitemaps. Respondents spent most of their time in the private arena, in their own homes, and the homes of their parents. Many also spent time in the semi-private arena, in places such as day centres and care settings. Some also spent time in the public arena, especially the neighbourhood. They experienced all three arenas both positively and negatively and associated each one with self-determination and community, as well as with demands and solitude. Young people’s activities and experiences were formed by the various arenas and by their social relationships, as well as by specific strategies for handling different situations

A need for “good eyes”: Experiences told by patients diagnosed with psychosis

This study highlights experiences of psychiatric care described by patients diagnosed with psychosis. The aim was to investigate how patients, based on earlier experiences, described their wishes and needs regarding the psychiatric care system. Data comprised material from four focus groups; analysis used an inductive thematic approach. Relationships with staff emerged as a recurring theme. During periods of psychosis, patients needed staff to act as “parental figures,” providing care, safety, and help in dealing with overwhelming stimulation from the outside word. In the ensuing struggle to devise a livable life, the need for relationships recurred. In this phase, staff needed to give their time, provide support through information, and mirror the patient's capacity and hope. The patient's trials were described as threatened by a lack of continuity and non-listening professionals. It was important for staff to listen and understand, and to see and respect the patients' viewpoints

Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement

<p>Abstract</p> <p>Background</p> <p>Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner.</p> <p>Methods</p> <p>Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis.</p> <p>Results</p> <p>The four main categories that developed were:</p> <p>• Access to the professional midwife</p> <p>• Useful counselling</p> <p>• Stable motherhood in transition</p> <p>• Being a family living in a different culture</p> <p>Conclusion</p> <p>According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.</p> <p>Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost.</p> <p>Clinical implications</p> <p>There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.</p

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century