Target groups for prevention of neck/shoulder and low back disorders: an exploratory cluster analysis of working and living conditions

Musculoskeletal disorders (MSDs) have a multifactorial etiology. Therefore, a holistic approach to identifying target groups for primary/secondary prevention is essential. In this study, an exploratory person-oriented approach was applied, using cluster analysis of variables related to physical and psychosocial work conditions, and conditions in the private sphere, on a data set of 1,341 Swedish women and men who had not sought care for MSDs the 6 months preceding enrollment in the study. Three groups at risk and five "healthy" groups regarding MSDs were identified. Two of the risk groups had a strained situation regarding psychosocial work conditions or domestic/family conditions, respectively. The majority of individuals in these groups were women. The third risk group had a strained situation regarding both physical and psychosocial work conditions. This group consisted largely of men working in male-dominated jobs. The five healthy groups had low/moderate metabolic demands at work, and all of them having high proportions of subjects with moderate to high education, and fairly even distributions of men and women. In conclusion, the results indicate that gender-specific working and living conditions are associated with an increased risk for MSDs. The identification of these subgroups in the population may facilitate a selective prevention approach.     

Social work and Nordic welfare policies for children—present challenges in the light of the past1

The aim of this article is to explore welfare policies for children in five Nordic countries—Denmark, Finland, Iceland, Norway and Sweden—and in that context identify what kinds of issues and challenges social work is currently facing. The data reviewed consist of policy documents, law texts, official reports, statistics, professional texts, and previous research. Policies and laws on children's protection; provisions, including policies on state benefits and care for children; and the autonomous integrity of children in terms of the norms and policies concerning their participation, in particular in public everyday life, are analysed from a historical perspective. Hence, future challenges for social work are analysed in light of the past. Our conclusion is that social workers have a unique opportunity, based on their close encounters with children as clients, to work for the realisation of children's rights. Furthermore, by applying a holistic perspective to issues of childhood and parenthood, social workers can contribute to the development of knowledge on how welfare systems can meet the challenges brought about by the new ideas of children's rights, social changes, globalisation, and the new ideological concepts of risk that have arisen in child welfare.

Artikkeli tarkastelee lasten hyvinvointipolitiikan kehitystä viidessä Pohjoismaassa—Tanskassa, Suomessa, Islannissa, Norjassa ja Ruotsissa—ja sen valossa sitä millaisia kysymyksiä ja haasteita tämän päivän lasten hyvinvoinnin parissa tehtävä sosiaalityö kohtaa. Artikkelissa on käytetty aineistona erilaisia politiikkadokumentteja, lakeja, julkisia raportteja,tilastoja, professionaalisia kirjoituksia sekä aiempaa tutkimusta. Artikkelissa analysoidaan historiallisesta näkökulmasta lastensuojelun, sosiaalipalvelujen, lapsille suunnattujen sosiaalisten tukien sekä lasten osallistumista koskevia normeja ja toimintapolitiikkaa. Sosiaalityön tulevaisuushaasteita analysoidaan menneisyyden valossa. Johtopäätöksemme on, että sosiaalityöntekijöillä on ainutlaatuinen mahdollisuus, joka perustuu heidän läheisiin työskentelysuhteisiinsa vaikeissa elämäntilanteissa olevien lasten kanssa, olla lasten oikeuksien todellisia toimeenpanijoita. Lisäksi lapsuuden ja vanhemmuuden näkökulmat yhdistävästä toimintapaikastaan käsin juuri sosiaalityöntekijät voivat vaikuttaa tutkimukseen ja kehittämiseen niin, että hyvinvointipalvelut ja –etuudet kohtaisivat nykyistä joustavammin lasten oikeuksien, yleisen yhteiskuntamuutoksen, globalisaation ja kovin ideologisena pitämämme riskiajattelun haasteet.     

What explains variation in voluntary disclosure? A study of the annual reports of corporations listed on the Stockholm Stock Exchange

The demand for information and transparency from listed corporations has recently increased. In spite of an increased demand for mandatory disclosures from regulators, corporations choose to voluntarily disclose additional information in order to satisfy demands from the capital market. However, the extent and content of information in those voluntary disclosures vary across corporations. The aim of this study is to explain the variation in the content of information in voluntary disclosures by listed corporations. The analyses are based on data collected from 431 annual reports from corporations listed on the Stockholm Stock Exchange during the years 2002 and 2005. The findings support explanations from agency theory and positive accounting theory that size and the debt ratio are positively correlated with the content of information in voluntary disclosures. Corporations with a high share of management ownership disclosed less information than corporations with a low share of management ownership. The study also shows that variations in voluntary disclosures can be explained by factors derived from institutional theory and ‘international capital market pressures’. The results indicate that foreign ownership and international listing to some extent have a positive effect on the content of information in voluntary disclosures. Industry was another factor that had a significant influence on voluntary disclosures. One important finding is that regulation to some extent can stimulate voluntary disclosures; our results did not indicate an ‘unintended chilling effect’ due to too much regulation. In general, the corporations disclosed more voluntary information after the introduction of IFRS.     

Self reported fear of childbirth and its association with women's birth experience and mode of delivery: A longitudinal population-based study

ObjectiveTo explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery.DesignA longitudinal population-based study.PopulationPregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden.MethodDifferences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used.ResultsFOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5–10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2–5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1–20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4–11.7), emergency caesarean section (RR 2.4, CI 1.2–4.5) and primiparity (RR 1.9, CI 1.2–3.1).ConclusionFOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women's perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women's experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required.     

The protection of unrepresented patients in emergency care research

In emergency care research, it may be the case that neither informed consent nor surrogate consent is possible. In order to nonetheless allow for such research, codes and regulations of research ethics have increasingly incorporated provisions regarding this specific situation. The protection that those provisions offer need to be better understood. This article addresses in what ways they protect individuals, and especially the extent to which the suggested protection compensates for the loss of surrogate consent. The Declaration of Helsinki, the Additional Protocol to the Convention on Human Rights and Biomedicine, and the EU Clinical Trials Regulation serve as the main illustrations.     

Optimal planning of phase II/III programs for clinical trials with multiple endpoints

Owing to increased costs and competition pressure, drug development becomes more and more challenging. Therefore, there is a strong need for improving efficiency of clinical research by developing and applying methods for quantitative decision making. In this context, the integrated planning for phase II/III programs plays an important role as numerous quantities can be varied that are crucial for cost, benefit, and program success. Recently, a utility‐based framework has been proposed for an optimal planning of phase II/III programs that puts the choice of decision boundaries and phase II sample sizes on a quantitative basis. However, this method is restricted to studies with a single time‐to‐event endpoint. We generalize this procedure to the setting of clinical trials with multiple endpoints and (asymptotically) normally distributed test statistics. Optimal phase II sample sizes and go/no‐go decision rules are provided for both the “all‐or‐none” and “at‐least‐one” win criteria. Application of the proposed method is illustrated by drug development programs in the fields of Alzheimer disease and oncology.     

Standardisierte Qualitätsinformationen und ihr Einfluss auf die Wahl von Leistungsanbietern – Ergebnisse einer empirischen Studie am Beispiel der Qualitätsberichte von Krankenhäusern

This study analyses the impact of standardized quality information of complex services on decisions, exemplified for Germany’s hospital quality reports. The presumed impact of quality information on decisions is based on theoretical considerations and hypotheses are developed accordingly. Though results of two experiments show that simplified quality indicators used in the quality reports for hospitals basically lead to consistent decisions, results also show that the impact of standardized quality information on decisions is not stable. It is disturbed and superimposed by the effects of additionally presented quality information. Implications for competition on hospital markets and for the effectiveness of standardized quality information as they are used in the hospitals’ quality reports are discussed as well as general conclusions about standardized information of complex services are drawn.