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

Maternal Exposure to Air Pollution and Birth Outcomes

Background: The knowledge about air pollution effects on birth weight, prematurity and small for gestational age [SGA] in low-exposure areas is insufficient. Objectives: The aim of this birth cohort study was to investigate if low-level exposure to air pollution was associated with prematurity and foetal growth and if there are gender specific effects. Method: We combined high quality registry information on 81110 births with individually modeled exposure data at residence for nitrogen oxides [NOx] and proximity to roads with differing traffic density. The data were analyzed by using logistic and linear regression with and without potential confounders. Results: An increased risk for babies being SGA was observed when highest and lowest NOx quartiles were compared, adjusting for maternal age, smoking, gender and year of birth. After additional adjustment for maternal country of origin and parity (which were highly intercorrelated), the increase was no longer statistically significant. However, in subgroup analysis when highest and lowest NOx quartiles were compared, there was still an increased risk for SGA for baby girls Odds Ratio [OR] 1.12 (95% Confidence Interval [CI] 1.01, 1.24), and also if mothers had not changed residency during pregnancy OR 1.09 (95% CI 1.01, 1.18). The confounders with the greatest impact on SGA were parity and country of origin. Concerning prematurity, the prevalence was lower in the three higher NOx exposure quartiles compared to the lowest category. Conclusion: For future studies on air pollution effects on birth outcomes careful control of confounding is crucial

Representations of Children’s Voices about Their Health in Social Services Arguments in Support of Their Decision

Research points to the importance of involving children in social investigations, since their perception of their own situation and needs may differ from what others take to be the case. There is however no specific recommendation of how children’s voices should be inscribed in such investigations. This study explores if and how children’s voices are represented in the final part of the social investigations where social workers argue in support of their decision. It has a specific focus on how children’s voices about their health are included when, at the point of initiating an investigation, concerns have been raised about their physical and psychological well-being. Inspired by a social constructionist and discursive analytical approach we analyzed 60 arguments in as many social investigations. The findings are that children’s psychological-, physical health or general well- being was mentioned in 46 of the 60 argumentations. The child’s own thoughts about his or her health were represented in12 of these 46 arguments. Instead, children’s health was mostly represented by referrals to other persons. In those 12 arguments where children’s views are presented they were reported in different ways. Their view could, for example, be sparingly reported and be used in order to confirm a previous statement or opinion. Two of the cases go more into details about what the children actually have said about their health. We conclude that if the representation of the child’s own voice is excluded it is difficult to understand if and how children’s perspective of their health has been taken into consideration in the decision process

Looking for "The Equalizer" in antenatal care : developing and evaluating language-supported group antenatal care in Sweden

Group antenatal care (gANC) is an antenatal care (ANC) model that aims to empower women and has demonstrated potential to improve outcomes for groups of women with poorer reproductive health outcomes. The overall aim of this thesis was to develop and test the acceptability and impact of language-supported gANC for Somali-born women in Sweden. The purpose of the intervention was to improve experiences of antenatal care, emotional well-being, knowledge about childbearing and the Swedish healthcare system, and ultimately, pregnancy outcomes. Experiences of standard ANC were explored in focus group discussions with parents and midwives (Study I). Challenges and barriers in standard antenatal were described, both related to the encounters between midwives and parents-to-be, and organizational challenges. Utilising data from Study I, “language-supported group antenatal care” was developed and implemented in one clinic for 18 months. The intervention was evaluated, and women’s care experiences and emotional wellbeing were compared with those of women offered standard care (historical controls) and those subsequently offered gANC (intervention). Data were collected by means of questionnaires at baseline, in late pregnancy and at 6–8 weeks postpartum (Study II). The development, implementation, and feasibility of the intervention was assessed through a process evaluation using mixed data sources (observations, interviews, questionnaires, etc.) (Study III). In study II, no differences between the intervention group and the control group on the primary outcome of women’s overall rating of antenatal care were found. The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference –1.89; CI 95% –3.73 to –0.07). Women in gANC were happier with received pregnancy and birth information; e.g., in the case of caesarean sections, where 94.9% believed the information was sufficient compared to 17.5% in standard care (p <0.001) in late pregnancy. In study III, women in language-supported gANC thought it was a positive experience as a complement to individual care, but the intervention was not successful at involving partners in ANC. In gANC, the midwives and women got to know each other better. The main mechanism of impact was more comprehensive care. The position of women was strengthened in the groups, and the way midwives expanded their understanding of the women, and their narratives, was promising. This evaluation suggests potential for language-supported gANC to improve information provision and knowledge acquisition for Somali–Swedish women during pregnancy (with residence in Sweden ˂10 years). Language-supported gANC is feasible and relevant if there is an adequate number of pregnant migrant or minority women in an uptake area who share a common language. To be feasible in other settings, gANC requires adaptations to local context. Reflection is called for when forming groups based on ethnicity or language, to avoid potential unintended consequences such as reinforcing stereotypes by grouping people according to country of birth or reducing privacy for individual women. The “othering” of women in risk groups should be avoided. There may also be a trade-off in gANC between peer-to-peer support and other important aspects such as the inclusion of partners and integration/inclusion in regular birth preparation and parenting activities. Person-centring seemed to be enhanced with gANC in this study with Somali–Swedish women. ANC interventions including gANC that target inequalities between migrants and non-migrants should adapt a culturally sensitive person-centred approach, as a means of providing individually tailored high quality care that counteracts stereotypes and biases

Views and experiences of men who have sex with men on the ban on blood donation: a cross sectional survey with qualitative interviews.

OBJECTIVE: To explore compliance with the UK blood services' criterion that excludes men who have had penetrative sex with a man from donating blood, and to assess the possible effects of revising this policy. DESIGN: A random location, cross sectional survey followed by qualitative interviews. SETTING: Britain. PARTICIPANTS: 1028 of 32,373 men in the general population reporting any male sexual contact completed the survey. Additional questions were asked of a general population sample (n=3914). Thirty men who had had penetrative sex with a man participated in the qualitative interviews (19 who had complied with the blood services' exclusion criterion and 11 who had not complied). Main outcome measure Compliance with the blood services' lifetime exclusion criterion for men who have had penetrative sex with a man. RESULTS: 10.6% of men with experience of penetrative sex with a man reported having donated blood in Britain while ineligible under the exclusion criterion, and 2.5% had donated in the previous 12 months. Ineligible donation was less common among men who had had penetrative sex with a man recently (in previous 12 months) than among men for whom this last occurred longer ago. Reasons for non-compliance with the exclusion included self categorisation as low risk, discounting the sexual experience that barred donation, belief in the infallibility of blood screening, concerns about confidentiality, and misunderstanding or perceived inequity of the rule. Although blood donation was rarely viewed as a "right," potential donors were seen as entitled to a considered assessment of risk. A one year deferral since last male penetrative sex was considered by study participants to be generally feasible, equitable, and acceptable. CONCLUSIONS: A minority of men who have sex with men who are ineligible to donate blood under the current donor exclusion in Britain have nevertheless done so in the past 12 months. Many of the reasons identified for non-compliance seem amenable to intervention. A clearly rationalised and communicated one year donor deferral is likely to be welcomed by most men who have sex with men

Breast cancer risk in mothers of twins.

The risk of breast cancer associated with delivering a twin birth was examined in a population-based nested case-control study of nearly 4800 Swedish women with breast cancer and 47000 age-matched control subjects. All were aged less than 50 years and parous. After adjustment for age at first birth and parity, a 29% reduction in breast cancer risk was observed in mothers of twins relative to those who were not (odds ratio = 0.71, 95% confidence interval 0.55-0.91). These results provide evidence that women who bear twins are at reduced risk of breast cancer, one explanation for which may be their unusual levels of hormonal exposure

Mentoring programs for Indigenous youth at risk

IntroductionThis Resource Sheet examines evidence for the effectiveness of mentoring programs in helping to set Indigenous young people at risk of engaging in antisocial and risky behaviours on healthier life pathways.Mentoring is a relationship intervention strategy that research is showing can have powerful and lasting positive impacts on behavioural, academic and vocational outcomes for at-risk youth. Costello and Thomson describe youth mentoring as follows:Youth mentoring is, according to the Australian Youth Mentoring Network, defined as ‘a structured and trusting relationship that brings young people together with caring individuals who offer guidance, support and encouragement’. The goal of youth mentoring is to enhance social engagement and thereby minimise negative behaviours through growth in social and developmental behaviours.There are two types of mentoring style found in the literature—natural and planned. Among Indigenous Australians, the natural or informal form of mentoring is often spontaneous through the Elders’ traditional role of sharing the wisdom, the knowledge and the spirit, which can draw Aboriginal people back to traditional ways. Elders play an extremely important role in Aboriginal families as role models, care providers and educators.This Resource Sheet focuses on the planned or formal form of mentoring, which often includes Elders as part of these programs. It does not, however, cover the following formal forms of mentoring:a detailed analysis of mentoring, which occurs within sporting and other programs. (This is covered, where relevant, in a forthcoming Resource Sheet titled Supporting healthy communities through sports and recreation programs.) mentoring embedded within broader youth diversionary or justice programs mentoring within cadetship or other vocational education programs. There is a strong body of literature on the types of youth mentoring programs and the dynamics of successful programs and mentoring relationships. This Resource Sheet draws on evidence from 45 studies. Over half were Australian studies, with additional evidence from research in other colonised nations such as New Zealand, Canada and the United States. Two-thirds of the studies were Indigenous-specific. A range of methodologies was used including evaluations, critical descriptions of programs, meta-analyses and research syntheses

To study the short-term outcome of multimodality treatment on morbidity and quality of life in patients with carcinoma oesophagus

Background: Oesophageal cancer is sixth most common cause of cancer related deaths worldwide. Despite complete resections, overall survival remained low. To improve the existing treatment combination of chemotherapy and radiotherapy in both neoadjuvant and adjuvant settings was introduced. Impact of treatment on quality of life, morbidities and toxicities associated with multimodality treatment in patients of carcinoma oesophagus was studied prospectively and retrospectively.Methods: A total of 40 patients histologically proven carcinoma of the oesophagus were enrolled in the study. Study included assessment of clinical features, risk factors, biopsy, multimodality treatment and associated morbidities and toxicities. Quality of Life (QOL) in patients of multimodality treatment assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Core 18 before, immediate post treatment and 6 months after completion of the planned treatment.Results: In 40 patients, male to female ratio was 1.10:1. Dysphagia was the leading complain. 3 patients were treated using neoadjuvant therapy (chemotherapy and radiotherapy followed by surgery) among them 2 patients expired, 1 patient is under regular follow up. 6 patients underwent upfront surgery followed by adjuvant therapy out of which 3 patients expired,15 patients were treated with curative intent by definitive chemotherapy and radiotherapy out of which only 7 patients survived for >1 year. 16 patients were treated with palliative intent (radiotherapy, chemotherapy, oesophageal stenting and feeding procedures) in which only 1 patient survived for 1 year.Conclusions: The present study demonstrates that patients over all QOL was reduced after treatment and in the follow up period which was due to the treatment related toxicities but in contrast symptom improvement was observed simultaneously

Family physicians' experiences when collaborating with district nurses in home care-based medical treatment. A grounded theory study

<p>Abstract</p> <p>Background</p> <p>This article concerns Swedish family physicians' (FPs) experiences collaborating with district nurses (DNs) when the DNs provide medical treatment for home care patients. The aim was to develop a model to illuminate this process from the FPs' perspective.</p> <p>Methods</p> <p>Semi-structured interviews were conducted with 13 FPs concerning one of their patients with home care by a DN. The interview focused on one patient's treatment and care by different care providers and the collaboration among them. Grounded theory methodology (GTM) was used in the analyses.</p> <p>Results</p> <p>It was essential for FPs to collaborate with and rely on DNs in the medical treatment of home care patients. According to the FPs, factors such as the disease, FPs' working conditions and attitude determined how much of the initiative in this treatment FPs retained or left to DNs. Depending on the circumstances, two different roles were adopted by the individual FPs: <it>medical conductors </it>who retain the initiative and <it>medical consultants </it>who leave the initiative to DNs. Factors as the disease, DNs' attitudes towards collaboration and DNs' working conditions influenced whether or not the FPs felt that grounds for relying on DNs were satisfactory. Regardless of the role of the FP, conditions for medical treatment were judged by the FPs to be good enough when the grounds for relying on the DN were satisfactory and problematic when they were not.</p> <p>Conclusions</p> <p>In the role of conductor, the FP will identify when the grounds for relying on the DN are unsatisfactory and be able to take action, but in the role of consultant the FP will not detect this, leaving home care patients without appropriate support. Only when there are satisfactory grounds for relying on the DN, will conditions for providing home care medical treatment be good enough when the FP adopts a consultative role.</p