Health care,social care or both? A qualitative explorative study of different focuses in long-term care of older people in France,Portugal and Sweden

Challenges with an ageing population are increasingly becoming a reality in the Western world. Since cognitive impairment increases with age, we can expect an increasing number of older people in need of care. The aim of this article is to describe, analyse and compare different focuses on care of older people with dementia, using examples from France, Portugal and Sweden. The questions are principally focused on the participants’ view about their tasks, the organisation of work, the professional role and cooperation with other professions. Everyday care was studied through observations and participant observations and the staff's opinion was explored by means of interviews. Twenty-two care settings for older people were included. The findings showed that France provided mainly ‘health care’, Sweden ‘social care’ and Portugal an integrated ‘health care and social care’. In a comparative perspective the Portuguese general care of older people, which focuses on integration of health care, social care and social work, also seems to provide care for older people suffering from dementia which best corresponds to the previously developed group living model.     

Cyberbullying and subjective health: A large-scale study of students in Stockholm,Sweden

The increase in the use of mobile phones and the Internet has given rise to new opportunities for people to meet and communicate. However, there are also dark sides to these new forms of communication. One of these is cyberbullying, i.e. bullying via mobile phone and the Internet. Given that cyberbullying is a relatively new phenomenon, empirical knowledge is still limited and particularly so in Sweden, which in international comparison has reported low rates of bullying in general. The aim of the study is to investigate: 1) the prevalence of cyberbullying among students in Stockholm, Sweden; 2) the overlap between cyberbullying and traditional forms of school bullying, and 3) the association between the experience of cyberbullying and subjective health. The study uses the Stockholm School Survey of 2008 which is a total population survey of students in grade 9 of compulsory school (i.e. aged 15–16) and in the second year of upper secondary school (i.e. aged 17–18) in Stockholm and eighteen of its surrounding municipalities (N = 22,544). About 5 % of the students are victims of cyberbullying, 4% are perpetrators, and 2% are both victims and perpetrators. There is some overlap between cyberbullying and traditional bullying: those who are victims of traditional bullying are at increased risk of also being victims of cyberbullying; while being a traditional bully is strongly associated with the likelihood of also being a cyberbully. However, many students who are involved in cyberbullying are not involved in traditional bullying. OLS regression analyses show that being a victim of cyberbullying remains associated with worse subjective health when being the victim of traditional bullying and socioeconomic factors are taken into account. In addition, perpetrators of cyberbullying as well as students who are both victims and bullies, have worse subjective health than those who are not involved in cyberbullying.     

Work and health in Gnosjö: a longitudinal study

This study includes women and men born between 1934 and 1953 in the municipality of Gnosj? in the south of Sweden and covers the period 1998 to 2001. Compared with the country, a large proportion of the population of the municipality of Gnosj? works in the manufacturing industry. The aim was to examine associations between physical and psychological stress factors in and outside work, sickness absence and cardiovascular and musculoskeletal diseases, from a gender perspective. Information about working conditions and other aspect of life was collected by a questionnaire in 1998, and register data about sickness absence, cardiovascular diseases and musculoskeletal diseases 1999-2001. The impact on sickness absence consisted mainly of demand and control aspects of the psychosocial working conditions, but also temporary employment and of low sense of coherence. In relation to musculoskeletal health, demand and control was important among women, but not among men. Very few physical factors in the work environment were related to musculoskeletal diseases. Low sense of coherence had an impact also on musculoskeletal diseases. Cardiovascular diseases among women were influenced by demand and control and by life style related factors. We hope that the knowledge gained from our study makes it possible to develop better tools for both the preventive work in Gnosj? and for the rehabilitation of the people already ill. Because of our holistic approach, both public health aspects and working life aspects are covered. The municipality of Gnosj? is small, and therefore foreseeable in a way that many municipalities are not. Still, we do believe that our finding, in this longitudinal study, can be of value also in the public efforts and the efforts to develop adequate and successful rehabilitation approaches.     

Relationship functioning and sexuality among people with multiple sclerosis

This study was concerned with how the sexuality and relationships of people with Multiple Sclerosis (MS) are different from those of people from the general population. Three‐hundred eighty‐one respondents (144 males, 237 females) with MS and 291 respondents (101 males, 190 females) from the general population participated in the study. Sexual satisfaction, sexual dysfunction, relationship satisfaction, and coping style were assessed among all respondents. Information was also obtained from people with MS regarding age of onset and diagnosis of symptoms, as well as severity of symptoms. Overall, males with MS experienced a higher frequency of sexual dysfunction than males from the general population, while females with MS only differed from females from the general population in their levels of masturbation and numbness of the genital area. Coping strategies and levels of cognitive functioning were important predictors of sexual satisfaction, sexual dysfunction, and relationship satisfaction for women with MS, but there were fewer coping or health‐related factors that predicted these variables among men with MS. The results of this study are discussed in terms of factors related to sexual satisfaction and positive interpersonal relationships. There is a need to conduct further research in this area so that professionals working with people with MS are informed on strategies to improve the sexuality and relationships of their clients' lives.     

Older people and poverty in rural Britain: Material hardships,cultural denials and social inclusions

This paper explores the relations between older people, poverty and place in rural Britain. It develops previous work on rural poverty that has pointed both to the significance of older people within the rural poor population and to their denials of poverty. The paper also connects with recent discussions on the complexity of relations between poverty and social exclusion in later life, as well as key themes emerging from studies of older people in disadvantaged urban neighbourhoods. Drawing on findings from a survey of 4000 households in rural Wales and interviews with older people in poverty in three rural places, the paper provides a detailed examination of the materialities and experiences of poverty among older people in rural places. In particular, it highlights how older poor groups construct their lives in complex terms with references made to both social inclusions and exclusions. The research also points to the significance of the socio-cultural contexts of place in shaping older people's understandings of poverty in rural areas.     

Exploring youths' perceptions of the hidden practice of youth work in increasing social capital with young people considered NEET in Scotland

This small-scale research explores the generation of social capital in young people growing up in one urban area and one rural area in Scotland via community-led youth work projects that aim to re-engage young people categorised as NEET (Not in Employment Education or Training). By looking at their varied and complex biographies, it considers young people's experiences and perceptions of their communities and their transitions from education to the workplace. Using social capital as a theoretical lens, we examined the impact that youth work can have not just on these important transitions but also upon the young people themselves. By visiting two different sites of engagement we were able to explore whether the type of initiative (media or sports) or place (urban or rural) had an impact on the generation of capital for young people. The youth work practice in both areas acted as a glue between the young people and their communities, creating opportunities where the two could be bound together and relationships created. This occurred in both sites regardless of the area or type of initiative and confirmed in this study that youth work acts as a site of capital building.     

Self-rated quality of life among the young unemployed and the young in work in northern Sweden

This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (H?rnquist's QLcs) covering life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", for young people aged 18-24 in a population-based cross-sectional study in northern Sweden. Of these, 651 were unemployed and 2802 were in work (employed, students and in military service). Results showed that the young unemployed exhibited poorer QoL than the young in work and the greatest difference was found regarding their financial situation. Young men rated somatic health and mental well-being higher than young women. However, QoL in other essential domains was rated higher by young women in work. Close friends and money reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a worse financial situation, shorter education, and fewer leisure activities with other people. Finally, it was concluded that while QoL is poorer when in unemployment - both for the young and those who are older (aged 25-64) - psychological well-being, in contrast to several previous studies, is even poorer for young people than for those who are older. This is worrying in a public health perspective and could have implications for unemployment policies for younger and less well-educated age groups.     

Pride, empowerment, and return to work: on the significance of promoting positive social emotions among sickness absentees

Sickness absence is a great public health problem and there is a lack of knowledge concerning the hows and whys of success or failure in promoting return to work of sick-listed persons. Discussions of and research into social and psychological aspects of this problem area are in need of theoretical contextualisation. In this paper it is suggested that theories of social emotions may be useful, and that the concept of empowerment can be applied provided that it is reasonably well defined. The notions of pride/shame and empowerment are elucidated and discussed, and it is shown that they can be related in the context of research into emotional dimensions of sickness absentees' experiences of the rehabilitation process in a way that may help to guide empirical studies. A simple model of hypothetical relations between pride/shame, empowerment/disempowerment, work ability, health, and return to work is sketched.     

Relationship functioning and sexuality among people with multiple sclerosis

This study was concerned with how the sexuality and relationships of people with Multiple Sclerosis (MS) are different from those of people from the general population. Three-hundred eighty-one respondents (144 males, 237 females) with MS and 291 respondents (101 males, 190 females) from the general population participated in the study. Sexual satisfaction, sexual dysfunction, relationship satisfaction, and coping style were assessed among all respondents. Information was also obtained from people with MS regarding age of onset and diagnosis of symptoms, as well as severity of symptoms. Overall, males with MS experienced a higher frequency of sexual dysfunction than males from the general population, while females with MS only differed from females from the general population in their levels of masturbation and numbness of the genital area. Coping strategies and levels of cognitive functioning were important predictors of sexual satisfaction, sexual dysfunction, and relationship satisfaction for women with MS, but there were fewer coping or health-related factors that predicted these variables among men with MS. The results of this study are discussed in terms of factors related to sexual satisfaction and positive interpersonal relationships. There is a need to conduct further research in this area so that professionals working with people with MS are informed on strategies to improve the sexuality and relationships of their clients lives.     

Well-being and occupational roles among middle-aged women

One purpose of the present study is to explore the stability of the pattern of health/work and sickness absence among middle-aged women over a period of three years. This study tested two hypotheses: (a) that enduringly healthy working women would perceive more valued occupational roles and higher well-being than long-term sick-listed women; (b) that high levels of well-being at baseline would predict enduring health and occupational role value at a 3-year follow-up. Middle-aged women (n = 208) answered a postal survey with the Role checklist, a well-being scale and questions about work and sickness situation. The results showed that there was a considerable variability in the pattern of health/work and sickness absence. The variability was greatest among the women who were long-term sick-listed at baseline, and the internal drop out was great among them. The results showed that the enduringly healthy women experienced a more valued worker role and higher well-being than the long-term sick-listed women. Furthermore, high levels of well-being concerning health and work predicted enduring health in the studied sample, and high well-being concerning work was predictive of a valued worker role. Interventions that enable women to develop valuable worker and leisure roles, as well as harmony between different roles, may be important constituents of health promotion/rehabilitation programmes.     

‘A frog in a well’: the exclusion of disabled people from work in Cambodia

Based on ethnographic research conducted in north‐west Cambodia in 2000–2001, this paper examines why disabled people experience systematic marginalisation in the labour market. Although there are no official data on the relationship between disability and employment status in Cambodia, this research suggests that disabled people are more likely than their able‐bodied counterparts to be unemployed, in low status occupations, earn less or be out of the labour market altogether. Consequently, disabled people are more likely to live in poverty, experience social isolation and poor mental health. I argue that disabled people’s social status effectively shapes their work patterns through (mis)conceptions that associate ‘disability’ with ‘inability’ to work and to be employable. This paper illustrates how geographical processes fix disabled people in their socio‐spatial place, which together with ideological and structural inequalities distinguish and entrench their poverty from that of other social groups.     

Prediction of future low levels of sickness absence among young persons sick listed with back, neck, or shoulder diagnoses

In recent years sickness absence has increased in most Western countries. Risk factors for sickness absence and disability pension have been emphasised in studies, while focus on factors predicting low sickness absence is very rare. This paper is an attempt to apply such a perspective in an 11-year prospective cohort study of young persons n = 213) who in 1985 were sick listed > or = 28 days with back, neck, or shoulder diagnoses. Having had no sick-leave spells > 14 days in 1992-1996 was used as the outcome measure. Sixty-nine persons (34%) had no such spells, with an unexpected similar proportion of men and women. Data on prior sick leave and demographic variables were analysed using univariate and multiple logistic regression. Factors that predicted low sickness absence were having prior low sickness absence, being a white-collar worker, and being married. We concluded that individuals with a history of low sickness absence have an increased odds for remaining in the work force after a single long sick-leave spell, and might need less attention in rehabilitation compared to persons with a history of high sickness absence. Focusing on low sickness absence led to different results than those discussed in previous studies on risk factors for disability pension.     

Organizational and health performance in small enterprises in Norway and Sweden

This article focuses on relationships between organizational factors such as leadership, learning, psychosocial work environment and quality aspects as they relate to organizational and health performance outcomes in 42 small enterprises in Norway and Sweden. A rather explorative analysis model was created using indicators that were based on theoretical concepts from a literature review and questionnaire data, concerning 988 employees and leaders. These indicators were then used for correlation analysis. The enterprise is the unit of analysis. Some strong links between organizational factors and organizational and health performance were found. There was also a strong relation between health performance and sickness absence. Using structural analyses, a structure containing six general components, and strong interrelationships between some indicators of organizational performance and health performance were found. It was also possible to position the enterprises according to two general dimensions. As a general guideline for action, the results tend to support the perspective that positive organizational development is related to health performance and a lowering of absence due to sickness. The findings support the strategies of practitioners who use a concept-driven or holistic approach that integrates several facets of workplace development.     

Is There Hidden Potential for Rural Population Growth in Sweden?

Rural depopulation is a concern in many countries, and various policy initiatives have been taken to combat such trends. This article examines whether hidden potential for rural population growth can be found in Sweden. If such potential exists, it implies that the development prospects for many rural areas are not as unpromising as they may seem today. If not, rapid rural depopulation can be expected and policymakers will have to increase their focus on how to lessen problems associated with population decline. We employ a combination of survey data and register data to identify the characteristics of people who have expressed a desire to move to rural areas and compare this population with those who actually do move to these areas. The results show that more people have rural residential preferences than the actual number of migrants to rural areas suggest. The findings indicate that there is a general potential for rural population growth; however, the characteristics of these two groups are similar and we cannot discern any group as constituting this hidden potential. Nonetheless, we argue that this potential is unlikely to be realized in terms of rural population growth and we discuss the further implications of these findings.     

Health,personal mobility and the use of health services in rural Norfolk

Trends towards the centralisation of both primary care and hospital services are increasing the distances that rural residents must travel to receive health care. Contradicting the widely held image of the healthiness of rural people, data from social surveys in Norfolk show that some of the remoter rural areas have populations with a relatively high need for health care. Furthermore, the groups with most need for health care (the old, the disabled, the poor, etc.) are also those with low levels of personal mobility, for whom travelling long distances to centralised health services is particularly difficult. After adjustments have been made for variations in need, it is shown that people in the remoter areas receive much less health care than comparable people in more accessible areas. However, branch surgeries do seem to make the general practitioner service more accessible, particularly to less mobile rural residents.     

Case management for people with psychiatric disabilities in rural Sweden; experiences from the implementation of a national policy

The aim is to analyse the implementation of a case manager-model in rural Sweden. A sample of 15 case management teams was selected. Written materials were collected and interviews on location were carried out. Results: rural case managers design their work methods themselves, which entail several deviations from the national policy guidelines in this field. The case management boards have a low capacity to direct and manage the activities of the case managers. Consequently, case managers develop into ‘welfare entrepreneurs’. One salient risk is that teams become isolated from the surrounding welfare system. In conclusion, the Swedish version of case management in rural areas is a result of local processes of adaptation and negotiation that result in services that differ from those envisaged in national policy guidelines.     

The periphery of care: Emergency services for homeless people in rural areas

Until recently, homelessness in rural areas has received little recognition because of overwhelming assumptions about the urban-centredness of homeless people and their needs. This paper seeks to build on recent research that has begun to uncover some of the problems and characteristics of rural homelessness, by suggesting two significant dynamics which together can shape the experience of different groups of homeless people in rural environments. First, rural places reflect particular local qualities which contextualise both the circumstances of homelessness and the provision of services in response to those circumstances. Secondly, the contemporary governance of homelessness unfolds rather unevenly in different rural areas, producing distinct local service environments with varying degrees of ‘insider’ and ‘outsider’ status in relation to joined-up responses to the needs of homeless people. These dynamics are articulated through three case studies: a remote friary in a deep rural area of southern England; a small hostel run by a vibrant non-statutory organisation in a small town in the west of England, and two advice centres in a coastal resort in the north-east of England. Through these case studies we highlight the importance of both local reactions to the homeless other, and local relations between central government funding, local authority initiatives and charitable organisations, in the production and consumption of spaces of care in settings set in, or serving, rural environments.     

Health maintenance antecedents among older citizens in rural and urban communities

The evidence is clear that rural older people in most nations are less physically healthy than their urban counterparts. Research suggests that such differences may be due more to lifestyle characteristics, biological factors and environmental conditions than to access to, or utilization of, medical services. Utilizing a statewide sample of Idaho residents this study compares the characteristics of those people associated with a disease prevention/health maintenance model and those associated with the medical or disease oriented model. Results show some clear differences in characteristics between people utilizing the two models of health care.     

Procedures when young people leave care — Views of 111 Swedish social services managers

In western societies, there is a general tendency towards a protracted transition to adulthood for young people, who thereby may become increasingly dependent on support from family. Young people leaving a placement in out-of-home care often lack such support, and will thus have a disadvantageous position compared to their peers. With the purpose of looking into the procedures when young people leave a placement in out-of-home care, telephone interviews were performed with 111 managers of social service units in two Swedish regions (West Sweden, and Stockholm Region), using a structured interview schedule. Answering rate was 99.1%.Only 6% of the managers had information of the young people's whereabouts once they had left care. 86-88% had general support programmes for all young people concerning housing, employment etc. but only 2-4% had specific programmes for young people leaving care. A majority of the managers were attentive of the difficulties the young people leaving care may encounter, but displayed little awareness of the consequences of a prolonged transition to adulthood, and the need for continued support after leaving care. Several managers referred to the general support of the Swedish welfare state, meaning that young people leaving care had the same access to support as all other young people in Sweden. Consequently, young people leaving care are at risk of being invisible in the welfare system and facing a compressed transition to adulthood.     

Perceived morbidity, utilisation of health services and factors affecting it in a rural area

A survey of perceived morbidity was carried out in rural population in eight villages and four wards of Saoner town, covering a total population of 8,876. The nature of illness was assessed by weekly visits to the families. History regarding treatment taken for disease and its source was taken. The overall incidence of perceived morbidity was 176.35 spells of sickness per 1000 population per month. Health care agency was contacted for 36.7 per cent spells of sickness. Utilisation of health services was found to be affected significantly by factors like age (chi 2 = 138.36), literacy (chi 2 = 14.123), type of occupation (chi 2 = 433.74), nature of illness (chi 2 = 83.578) and accessibility of health services. A health behaviour model of the population has also been discussed in this paper.