The influence of social and ethnic segmentation on consultation in primary health care

This paper analyses the utilization of primary health care by a population of whom 28% were not born in Sweden. The study emphasizes the impact of demography, housing and economic factors on the structure of the residential area. Households with meagre financial resources, large families and most of the immigrant population were tenants in multiple-occupancy blocks. Further, when demographic development was analysed over a decade, high turnover and a low median age were found in 2 of the multiple-occupancy areas, indicating social instability. The study revealed a process of both socioeconomic and ethnic segmentation (non-spatial segregation in a residential area). The age- and sex-standardized relative risks (RR) showed that the population in subareas consisting of multiple-occupancy housing in socially unstable areas also had an increased risk of having to visit primary health care. There were no differences in the number of visits to primary health care between people born in Sweden and those born outside Sweden (relative risk (RR) = 1.09,95% confidence interval (CI) = 0.90–1.30), but those born outside Sweden more often made visits that lasted longer than 30 minutes (odds ratio (OR) = 3.75, 95% CI = 2.09–6.71).     

Ethnicity, migration and health: A population-based study of 338 refugees from Latin America, 396 nonrefugee immigrants from Finland and 161 from southern Europe and 996 age-, sex- and education-matched controls from Sweden

This article shows the influence of being a refugee from Latin America or a nonrefugee immigrant from southern Europe or Finland on self-reported illness, controlling for social factors and lifestyle. The study population consisted of 338 Latin American refugees, a random sample of 396 Finnish and 161 southern European immigrants and 996 age-, sex- and education-matched Swedish controls. The data were analysed unmatched with logistic regression (multivariate analysis) in main effect models. The strongest independent risk indicator for long-term illness was being a Latin American refugee (estimated odds ratio (OR)=2.96, 95% confidence interval (CI)=2.19–3.82). There was a significant association between being a Latin American refugee and period prevalence, ill health and unsatisfied need for care. Being a southern European or Finnish immigrant was a risk indicator of ill health but was not associated with the other dependent factors. Not feeling secure in daily life was a strong risk indicator for long-term illness and ill health (estimated OR=1.89, 95% CI=1.26–2.76 and OR=3.04, 95% CI= 1.97–4.48) respectively). Being a Latin American refugee was equal in importance to traditional risk factors such as overweight and not taking regular exercise for long-term illness and ill health.     

Out-of-home care among immigrant children in Sweden: a national cohort study

We used data from several national registers for ten entire birth cohorts ( n  > 1 million) to examine the representation of first generation immigrant children among first time entries into out-of-home care (foster or residential care) at ages 7–12 and 13–17. Logistic regression models were used to adjust results for socioeconomic background factors. Immigrant children were categorised in six groups relating to birth country/continent. Compared with Swedish-born peers, immigrant children from non-European countries had between two- and three-fold sex and birth-year adjusted odds for being placed in care for the first time at ages 7–12. After adjustments for five socioeconomic background variables, none of these overrisks remained. Instead there was a tendency towards immigrant background being associated with reduced risks, statistically significant for immigrant children born in non-Nordic European countries. Immigrant children had between two- and six-fold age and birth-year adjusted odds for entering care for the first time during adolescence. After adjusting the results for socioeconomic background, only immigrant children born in Sub-Saharan Africa or in Asia outside the Middle East had significant overrisks for care entries at ages 13–17 (odds ratio = 1.5).     

Immigrants in Sweden's labour market during the 1980s

Using a new database, we studied the earnings of people born outside Sweden and those born in Sweden who were living in Sweden from 1978 to 1990. The results show that relative earnings of people born outside Sweden deteriorated. This is not only caused by an increasing proportion of immigrants from countries outside Europe but also by a deteriorating situation on the labour market for immigrants born in the Nordic countries or in other European countries.     

Poverty affects access to regular source of primary care among the general population in Hong Kong

A territory‐wide two‐stage stratified random sample of 2,282 community‐dwelling Hong Kong adults were surveyed between 2014 and 2015 to investigate the association between poverty and regular source of primary care utilization. Poverty was operationalized by income‐poverty and deprivation. About 94% of our sample reported having regular source of primary care (Western and/or Chinese medical practitioner) and about 69% among them were in private sector. Multivariable logistic regression showed that people who were income‐poor and deprived were less likely to have regular source of primary care (income‐poor: OR = 0.523, p = .027; deprived: OR = 0.488, p = .007) and visit private primary care doctors (income‐poor: OR = 0.445, deprived: OR = 0.222, both p < .0001). Those who had chronic diseases were more likely to have regular source of primary care (multimorbid: OR = 10.709, p < .0001), but less likely to access care in the private sector (one chronic disease: OR = 0.690, p = .019; multimorbid: OR = 0.374, p < .0001) than those without. Further, being older and less skilled were significantly associated with less likelihood of visiting a private doctor. Path analysis showed that the number of chronic diseases had significant indirect effect on having regular source of primary care with being income‐poor and deprived as the mediators (β = ?.0183, p = .0016). Therefore, despite a public health‐care system that aims to deny no one from adequate health care for lack of means, regular source of primary care in Hong Kong is found to be pro‐rich. Future policies should tackle the problem of health‐care inequalities to meet the needs of the underprivileged.     

Prevalence of mental health problems among children placed in out-of-home care in Denmark

This paper concerns the prevalence of mental health problems among children in family foster and residential care within a Danish context. All children, born in Denmark in 1995, who are or formerly have been placed in out-of-home care ( n = 1072), are compared with a group of vulnerable children of the same age, subjected to child protection interventions but living at home ( n = 1457, referred to as the 'in home care children'), and to all contemporaries who are not child protection clients ( n = 71 321, referred to as the 'non-welfare children'). Prevalence data are established on the basis of national administrative register data, including data on psychiatric diagnoses of the children, and on survey data scoring children in out-of-home care, in home care children, and non-welfare children by means of the Strengths and Difficulties Questionnaire (SDQ). Results show that 20% of children in out-of-home care have at least one psychiatric diagnosis compared to 3% of the non-welfare children. Almost half of the children in care (48%) are, furthermore, scored within the abnormal range of SDQ, compared to 5% of the non-welfare children.     

The residential home – what difference does it make?: Comparing the public systems of care for the elderly and disabled in two Swedish municipalities

Two municipalities in Sweden – Solna and Sigtuna – have taken part in a project (the ASIM project) aimed at developing a system for monitoring and analysing the public system of long-term care and assistance for elderly and disabled people. The two municipalities have chosen different alternatives in the question of residential homes. In Solna they have been retained and in Sigtuna they have been converted into sheltered housing. By separating the clients into different classes of dependence using the ASIM assessment, it is shown that in Solna, compared with Sigtuna, fewer of the most dependent clients are in long-term hospital care and fewer of the high-medium category are in domiciliary care. The data were used to calculate the distribution of the clients and the average dependence on the different levels of care if Solna were to apply the care pattern of Sigtuna and vice versa.     

Effects of Placement Changes on Health Insurance Stability Among a National Sample of Children in the Child Welfare System

ABSTRACT

Children in the child welfare system have entitlements to health insurance coverage—critical because of their considerable physical and mental health needs—based largely on their placement status. This study conducted path and transitions analyses on data from the National Survey of Child and Adolescent Well-Being (3,801 children followed-up for 3 years) to examine the interplay between placement changes and insurance stability. Children maintained in-home at Wave 1 had significantly lower odds of being insured (OR = 0.7); children transitioning from out-of-home placement to in-home care had significantly lower odds of maintaining insurance coverage (OR = 0.6). Child welfare workers working with children maintained in-home and those being reunified should safeguard the children's insurance status. Policy makers should consider extension of categorical eligibility to all children presenting to child welfare agencies in order to assure access to needed services for these vulnerable children.     

Drugs,Alcohol And Respiratory Diseases And Social Class in Sydney Western Metropolitan Areas: A Research Note

An analysis of social and health data available from the 1986 census and hospital records for the Western Metropolitan Region of Sydney, indicated that there was a wide variation in social class ratio, percent of Australian born people, respiratory disease and drug and alcohol morbidity. There was a significant negative correlation between social class and percent of Australian born people. There was no relationship between mortality rates from respiratory diseases and social class ratio or percent of Australian born people. However there was a significant correlation of drug and alcohol morbidity with the social class ratio. External and internal factors may explain these findings.     

Drugs,Alcohol And Respiratory Diseases And Social Class in Sydney Western Metropolitan Areas: A Research Note

An analysis of social and health data available from the 1986 census and hospital records for the Western Metropolitan Region of Sydney, indicated that there was a wide variation in social class ratio, percent of Australian born people, respiratory disease and drug and alcohol morbidity. There was a significant negative correlation between social class and percent of Australian born people. There was no relationship between mortality rates from respiratory diseases and social class ratio or percent of Australian born people. However there was a significant correlation of drug and alcohol morbidity with the social class ratio. External and internal factors may explain these findings.     

Into adulthood: a follow-up study of 718 young people who were placed in out-of-home care during their teens

In this study, national register data were used to analyse long‐term outcomes at age 25 for around 700 Swedish young people placed in out‐of‐home care during their teens. The sample consisted of 70% of all 13‐ to 16‐year olds who entered out‐of‐home care in 1991. Results revealed a dividing line between young people placed in care for behavioural problems and those placed for other reasons. Young woman and men from the first group had – in comparison with peers who did not enter care – very high rates of premature death, serious involvement in crime, hospitalizations for mental‐health problems, teenage parenthood, self‐support problems and low educational attainment. Young people who were placed for other reasons had better outcomes, but still considerably worse than non‐care peers. Young women tended to do better than young men, regardless of reasons for placement. Very high rates of hospitalizations for mental health problems were found among young people placed for behavioural problems. Breakdown of placement was found to be a robust indicator of poor long‐term prognosis.     

Is disability pension related to quality of life?

The aim of this study was to investigate the quality of life (QL) among early retired pensioners (ERPs) granted a disability pension due to musculoskeletal disorders. A questionnaire was sent to 450 ERPs and to a control group of the same size living in the municipality of Kristianstad, Sweden. Interviews were performed with ERPs with positive and progressing QL (n = 29) and ERPs with negative and declining QL (n = 26). The QL among ERPs was lower than among controls. ERPs below 55 years of age and immigrant ERPs had higher odds for a low/declining QL than older and Swedish ERPs, respectively. The most important domain influencing the QL among ERPs was the relationship or lack of relationship with family and others. ERPs with low/declining QL pointed out that poor subjective health status and economic problems were crucial reasons for their low QL.     

Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

Summary The delivery of health and social care has undergone massivechange in the UK in the 1990s. A key factor in the drive forreform was the failure of joint working arrangements betweenhealth and social services and the need to provide integratedcare for people who have overlapping health and social careneeds. This article draws on a research study investigatingthe community care provided to people with Parkinson's diseasein the wake of the 1990 National Health Service and CommunityCare Act. As a chronic progressive disease predominantly affectingolder people, the management of Parkinson's provides an exemplarof some of the key features of supporting people with continuingcare needs. This study found serious deficits in the assessmentand meeting of need, arising from weaknesses at the health andsocial care interface. The article concludes by consideringan approach which resources and supports the service user/carerin managing their own care pathway.     

Enhancing the resilience of children and young people in public care by mentoring their talents and interests

It is argued that the progress and resilience of young people in public care can be greatly enhanced by attention to the value of cultural, sporting and other activities in their lives. Sensitive mentoring of the young person in these activities by concerned adults – members of the child's social network or volunteers – can foster the potential of the young person, build self-esteem, strengthen mental health and open new social relationships beyond the care system. A series of case illustrations are used to demonstrate how such involvement in activities can greatly improve the prospects for a more successful transition out of care. It is suggested that the potential of this neglected dimension of care can only be fully realized through alert professional practice, imaginative engagement with potential 'natural' mentors, supportive agency policy, effective care planning systems, and relevant training and professional supervision for social workers.     

Attachment and adaptive skills in children of international adoption

The attachment pattern of a sample of 168 internationally adopted children was explored in this study using the semi‐structured Friends and Family Interview. The pattern was analysed in relation to the development of adaptive skills as an expression of the children's resilience. The secure attachment pattern rates were slightly lower and the insecure attachment patterns were considerably higher than those of normative samples from the previous studies. The children from Eastern Europe demonstrated a more insecure attachment pattern (odds ratio [OR]= 2.46; confidence interval [CI]= 1.23–3.94), and their scores on the adaptive skills scales were lower than the scores of children from other countries (OR = 2.62; 95% CI = 1.02–6.72). These results help to identify the groups at risk of failing to develop secure attachment patterns and appropriate adaptive skills, and should provide valuable information for designing effective interventions.     

Informal care in Sweden: a typology of care and caregivers

This study describes and analyses the types of informal care provided in Sweden and whether it is possible to distinguish different types of carers. Data were collected in a Swedish county in 2000, by means of telephone interviews. The net sample consisted of 2,697 individuals 18–84 years old, and the response rate was 61 per cent. The results showed that there were large differences in the numbers of male and female carers when the data were divided into a typology of care categories based on different caring tasks. Women were much more likely than men to be involved at the 'heavy end' of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely to provide some kind of practical help for a mother or a neighbour/friend. Even though the Swedish welfare state has been described as universal and characterised by an extensive system of benefits and services intended to cover the entire population, the results here indicate that informal care plays an important role and that the gender role patterns are similar to those observed in other types of welfare state. When discussing support systems it is important for social policy to develop programmes that take into account the support needs of both caregivers and care recipients, and not to see their needs in isolation from the social care system as a whole.     

Unheard voices,unmapped terrain: Care work in long‐term residential care for older people in Canada and Sweden

Daly T, Szebehely M. Unheard voices, unmapped terrain: care work in long‐term residential care for older people in Canada and Sweden This article aims to contribute to comparative welfare state research by analysing the everyday work life of long‐term care facility workers in Canada and Sweden. The study's empirical base was a survey of fixed and open‐ended questions. The article presents results from a subset of respondents (care aides and assistant nurses) working in facilities in three Canadian provinces (n= 557) and across Sweden (n= 292). The workers' experiences were linked to the broader economic and organisational contexts of residential care in the two jurisdictions. We found a high degree of country‐specific differentiation of work organisation: Canada follows a model of highly differentiated task‐oriented work, whereas Sweden represents an integrated relational care work model. Reflecting differences in the vertical division of labour, the Canadian care aides had more demanding working conditions than their Swedish colleagues. The consequences of these models for care workers, for older people and for their families are discussed.