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  • 1.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hensing, G
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    McKenzie, L
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Stridsman, A-K
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Prescribing benzodiazepines - a critical incident study of a physician dilemma.  1999In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 49, p. 459-467Article in journal (Refereed)
  • 2. Bolin, K
    et al.
    Lindgren, B
    Lindström, M
    Nystedt, Paul
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Management and Economics, Economics and Economic History.
    Investments in social capital - Implications of social interactions for the production of health2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 56, no 12, p. 2379-2390Article in journal (Refereed)
    Abstract [en]

    This paper develops a theoretical model of the family as producer of health- and social capital. There are both direct and indirect returns on the production and accumulation of health- and social capital. Direct returns (the consumption motives) result since health and social capital both enhance individual welfare per se. Indirect returns (the investment motives) result since health capital increases the amount of productive time, and social capital improves the efficiency of the production technology used for producing health capital. The main prediction of the theoretical model is that the amount of social capital is positively related to the level of health, individuals with high levels of social capital are healthier than individuals with lower levels of social capital, ceteris paribus. An empirical model is estimated, using a set of individual panel data from three different time periods in Sweden. We find that social capital is positively related to the level of health capital, which supports the theoretical model. Further, we find that the level of social capital (1) declines with age, (2) is lower for those married or cohabiting, and (3) is lower for men than for women.

  • 3.
    Broqvist, Mari
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    It takes a giraffe to see the big picture - Citizens' view on decision makers in health care rationing2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 128, p. 301-308Article in journal (Refereed)
    Abstract [en]

    Previous studies show that citizens usually prefer physicians as decision makers for rationing in health care, while politicians are downgraded. The findings are far from clear-cut due to methodological differences, and as the results are context sensitive they cannot easily be transferred between countries. Drawing on methodological experiences from previous research, this paper aims to identify and describe different ways Swedish citizens understand and experience decision makers for rationing in health care, exclusively on the programme level. We intend to address several challenges that arise when studying citizens' views on rationing by (a) using a method that allows for reflection, (b) using the respondents' nomination of decision makers, and (c) clearly identifying the rationing level. We used phenomenography, a qualitative method for studying variations and changes in perceiving phenomena. Open-ended interviews were conducted with 14 Swedish citizens selected by standard criteria (e.g. age) and by their attitude towards rationing. The main finding was that respondents viewed politicians as more legitimate decision makers in contrast to the results in most other studies. Interestingly, physicians, politicians, and citizens were all associated with some kind of risk related to self-interest in relation to rationing. A collaborative solution for decision making was preferred where the views of different actors were considered important. The fact that politicians were seen as appropriate decision makers could be explained by several factors: the respondents' new insights about necessary trade-offs at the programme level, awareness of the importance of an overview of different health care needs, awareness about self-interest among different categories of decision-makers, including physicians, and the national context of long-term political accountability for health care in Sweden. This study points to the importance of being aware of contextual and methodological issues in relation to research on how citizens experience arrangements for rationing in health care.

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  • 4.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Alma
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Understanding and preventing situations of abuse in health care: Navigation work in a Swedish palliative care setting2019In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 222, p. 52-58Article in journal (Refereed)
    Abstract [en]

    In their everyday work, health professionals find themselves in situations that they perceive to be abusive to patients. Such situations can trigger feelings of shame and guilt, making efforts to address the problem among colleagues a challenge. This article analyzes how health professionals conceptualize abusive situations, and how they develop collective learning and explore preventive strategies. It is based on an interactive research collaboration with a hospice and palliative care clinic in Sweden during 2016–2017. The empirical material consists of group discussions and participant observations collected during interactive drama workshops for all clinic staff. Based on three types of challenges in the material, identified through thematic analysis, we establish the concept of navigation work to show how health professionals prevent or find ways out of challenging and potentially abusive situations. First, the navigation of care landscapes shows how staff navigate the different territories of the home and the ward, reflecting how spatial settings construct the scope of care and what professionals consider to be potentially abusive situations. Second, the negotiation of collective navigations addresses the professionals' shared efforts to protect patients through the use of physical and relational boundaries, or mediating disrupted relationships. Third, the navigation of tensions in care highlights professionals’ strategies in the confined action space between coercing and neglecting patients who oppose necessary care procedures. Theoretically, the concept of navigation work draws upon work on care in practice, and sheds light on the particular kind of work care professionals do, and reflect on doing, in order to navigate the challenges of potentially abusive situations. By providing a perspective and shared vocabulary, the concept may also elicit ways in which this work can be verbalized, shared, and developed in clinical practice.

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  • 5.
    Clark, Andrew
    et al.
    School of Health and Society, University of Salford, Salford, Greater Manchester, UK.
    Campbell, Sarah
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Keady, John
    School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
    Kullberg, Agneta
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Manji, Kainde
    University of Salford, Salford, Greater Manchester, UK.
    Rummery, Kirstein
    Faculty of Social Science, University of Stirling, Colin Bell Building, Stirling, UK.
    Ward, Richard
    Faculty of Social Science, University of Stirling, Colin Bell Building, Stirling, UK.
    Neighbourhoods as relational places for people living with dementia2020In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 252Article in journal (Refereed)
    Abstract [en]

    An increase in the number of people living independently with dementia across the developed world has focused attention on the relevance of neighbourhood spaces for enabling or facilitating good social health and wellbeing. Taking the lived experiences and daily realities of people living with dementia as a starting point, this paper contributes new understanding about the relevance of local places for supporting those living with the condition. The paper outlines findings from a study of the neighbourhood experiences, drawing on new data collected from a creative blend of qualitatively-driven mixed methods with people living in a diverse array of settings across three international settings. The paper details some of the implications of neighbourhoods as sites of social connection based on material from 67 people living with dementia and 62 nominated care-partners. It demonstrates how neighbourhoods are experienced as relational places and considers how people living with dementia contribute to the production of such places through engagement and interaction, and in ways that may be beneficial to social health. We contend that research has rarely focused on the subjective, experiential and ‘everyday’ social practices that contextualise neighbourhood life for people living with dementia. In doing so, the paper extends empirical and conceptual understanding of the relevance of neighbourhoods as relational sites of connection, interaction, and social engagement for people living with dementia.

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  • 6.
    Dozet, A.
    et al.
    Department of Community Medicine, Lund University, Lund, Sweden, Lund University, Centre for Health Economics, Lund, Sweden, Department of Economics, Lund University, Lund, Sweden.
    Lyttkens, C.H.
    Department of Community Medicine, Lund University, Lund, Sweden, Lund University, Centre for Health Economics, Lund, Sweden, Department of Economics, Lund University, Lund, Sweden, Department of Economics, Lund University, P.O. Box 7082, SE-220 07 Lund, Sweden.
    Nystedt, Paul
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Management and Engineering, Economics .
    Health care for the elderly: Two cases of technology diffusion2002In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 54, no 1, p. 49-64Article in journal (Refereed)
    Abstract [en]

    Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old. © 2001 Elsevier Science Ltd. All rights reserved.

  • 7.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Resource Dependency, Organised Medicine and the State: Quality Control in Sweden.1999In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 49, p. 405-424Article in journal (Refereed)
  • 8.
    Garpenby, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Nedlund, Ann-Charlotte
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Political strategies in difficult times - The "backstage" experience of Swedish politicians on formal priority setting in healthcare2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 63-70Article in journal (Refereed)
    Abstract [en]

    This paper contributes to the knowledge on the governing of healthcare in a democratic context in times of austerity. Resource allocation in healthcare is a highly political issue but the political nature of healthcare is not always made clear and the role of politicians is often obscure. The absence of politicians in rationing/disinvestment arrangements is usually explained with blame-shifting arguments; they prefer to delegate "the burden of responsibility" to administrative agencies or professionals. Drawing on a case where Swedish regional politicians involved themselves in setting priorities at a more detailed level than previously, the findings suggest that the subject of "blame avoidance" is more complicated than usually assumed. A qualitative case study was designed, involving semi-structured interviews with 14 regionally elected politicians in one Swedish health authority, conducted in June 2011. The interviews were analysed through a thematic analysis in accordance with the "framework approach" by Ritchie and Lewis. Findings show that an overarching strategy among the politicians was to appear united and to suppress conflict, which served to underpin the vital strategy of bringing the medical profession into the process. A key finding is the importance that politicians, when appearing "backstage", attach to the prevention of blame from the medical profession. This case illustrates that one has to take into account that priority settings requires various types of skills and knowledges - not only technical but also political and social. Another important lesson points toward the need to broaden the political leadership repertoire, as leadership in the case of priority setting is not about politicians being all in or all out. The results suggest that in a priority-setting process it is of importance to have politics on-board at an early stage to secure loyalty to the process, although not necessarily being involved in all details.

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  • 9.
    Guntram, Lisa
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    "Differently normal" and "normally different": Negotiations of female embodiment in women's accounts of 'atypical sex' development2013In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 98, p. 232-238Article in journal (Refereed)
    Abstract [en]

    During recent decades numerous feminist scholars have scrutinized the two-sex model and questioned its status in Western societies and medicine. Along the same line, increased attention has been paid to individuals experiences of atypical sex development, also known as intersex or disorders of sex development (DSD). Yet research on individuals experiences of finding out about their atypical sex development in adolescence has been scarce. Against this backdrop, the present article analyses 23 in-depth interviews with women who in their teens found out about their atypical sex development. The interviews were conducted during 2009-2012 and the interviewees were all Swedish. Drawing on feminist research on female embodiment and social scientific studies on diagnosis, I examine how the women make sense of their bodies and situations. First, I aim to explore how the women construe normality as they negotiate female embodiment. Second, I aim to investigate how the divergent manners in which these negotiations are expressed can be further understood via the womens different access to a diagnosis. Through a thematic and interpretative analysis, I outline two negotiation strategies: the "differently normal" and the "normally different" strategy. In the former, the women present themselves as just slightly different from normal women. In the latter, they stress that everyone is different in some manner and thereby claim normalcy. The analysis shows that access to diagnosis corresponds to the ways in which the women present themselves as "differently normal" and "normally different", thus shedding light on the complex role of diagnosis in their negotiations of female embodiment. It also reveals that the women make use of what they do have and how alignments with and work on norms interplay as normality is construed.

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  • 10.
    Guntram, Lisa
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Zeiler, Kristin
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    ‘You have all those emotions inside that you cannot show because of what they will cause’: Disclosing the absence of one’s uterus and vagina2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 167, p. 63-70Article in journal (Refereed)
    Abstract [en]

    This article examines young women's experiences of telling others that they have no uterus and no, or a so-called small, vagina – a condition labelled ‘congenital absence of uterus and vagina’, which falls within the larger category of ‘atypical’ sex development. Our aim is to investigate how affective dissonances such as fear and frustration are expressed in young women's narratives about letting others know about their ‘atypical’ sex development, and how these women narrate desired steps to recognition. By drawing on feminist writings on the performativity of affects or emotions, we examine what affective dissonances accomplish within three identified narratives: how affective dissonances may contribute to the women's positioning of themselves vis-à-vis other individuals and how affective dissonances can imply a strengthening and/or questioning of norms about female embodiment and heterosexuality. This allows us to tease out how routes for questioning of these norms become available through the three narratives that together form a storyline of coming out about a congenital absence of a uterus and vagina in the Swedish context. Furthermore, by demonstrating how others' responses shape the women – their understandings of their own bodies, their envisaged future disclosures and their relations – our analysis highlights the multifaceted intersubjective and in other ways relational, affective and temporal dimensions of coming out about one's 'atypical' sex development.

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  • 11.
    Gustafsson Stolt, Ulrica
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Liss, Per-Erik
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Attitudes to bioethical issues: a case study of a screening project2002In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 54, no 9, p. 1333-1344Article in journal (Refereed)
    Abstract [en]

    Commonly expressed in theoretical discussions about ethical problems in the context of epidemiology and screening is the need for more data. A study was carried out involving 21 explorative interviews with participant and nonparticipant mothers in a neonatal research screening project in progress in Sweden, ABIS (All Babies in Southeast Sweden). The respondents were asked, by way of open-ended questions, to give their opinions about certain ethical issues: informed consent; reasons for joining/declining; surrogate decision; the collection, analysis and storage of written and “live” material (biobanks); intervention etc.

    The ethical implications mentioned in the literature mostly concern the risk of creating distress and anxiety (anxiety and possible stigmatisation in respect of positive or false-positive results, worry about material collected and stored, distress caused by blood sampling procedures, etc.). Our results do not support the idea that the risks are substantial. The respondents rather indicate an attitude of benevolence—they are positive both to the current research on children, to the material they contribute (both written material and “biomaterial”), to possible results and intervention plans. On the other hand the participants expressed concern about the storage of material and the right to be informed of any screening/project results. Further studies in this field are needed and would be of help in theoretical discussion, the work of ethical committees and the designing of, for example, screening and research projects.

  • 12.
    Johanson, Marita
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Thematic Studies, Department of Communications Studies.
    Sätterlund-Larsson, Ullabeth
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Thematic Studies, Department of Communications Studies.
    Säljö, Roger
    Svärdsudd, Kurt
    Lifestyle discussion in the provision of health care. An empirical study of patient-physician interaction1998In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 47, no 1, p. 103-112Article in journal (Refereed)
  • 13.
    Kristenson, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Impact of socioeconomic determinants on psychosocial factors and lifestyle - implications for health service: The Swedish experience2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, no 5, p. 661-664Article in journal (Refereed)
    Abstract [en]

    n/a

  • 14.
    Kristenson, Margareta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Eriksen, H R
    Biological and Medical Psychology University of Bergen.
    Sluiter, J K
    Academic Medical Center University of Amsterdam.
    Starke, D
    Medical Sociology University of Duesseldorf.
    Ursin, H
    Biological and Medical Psychology University of Bergen.
    Psychobiological mechanisms of socioeconomic differences in health2004In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 58, no 8, p. 1511-1522Article in journal (Refereed)
    Abstract [en]

    The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.

  • 15.
    Mitchell, Jeffrey
    et al.
    Department of Sociology, Umeå University, Umeå, Sweden.
    Chihaya, Guilherme Kenji
    Linköping University, Department of Management and Engineering, The Institute for Analytical Sociology, IAS. Linköping University, Faculty of Arts and Sciences. Department of Geography, Umeå University, Umeå, Sweden.
    Tract level associations between historical residential redlining and contemporary fatal encounters with police2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 302, article id 114989Article in journal (Refereed)
    Abstract [en]

    How does structural racism influence where people are killed during encounters with police? We analyzed geo-located incidents of fatal encounters with police that occurred between 2000 and 2020 in Census tracts that received a classification by the Home Owners Loan Corporation (HOLC) during the 1930's. Statistical models show that incidents of fatal encounters with police in formerly redlined areas are 66% more likely than in zones that received the most favorable “A” rating. These differences remain even when tract historical and contemporary racial compositions, along with contemporary economic conditions, are taken into account. The effects of contemporary racial composition and economic conditions overshadow the effect of zone classifications only in areas with high proportions of Black residents or residents in poverty (>60% or >30% respectively). These findings provide evidence of structural biases in policing rooted in historical segregation policies.

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  • 16.
    Mulinari, Shai
    et al.
    Lund Univ, Sweden.
    Vilhelmsson, Andreas
    Lund Univ, Sweden.
    Ozieranski, Piotr
    Univ Bath, England.
    Bredström, Anna
    Linköping University, Department of Culture and Society, Division of Migration, Ethnicity and Society (REMESO). Linköping University, Faculty of Arts and Sciences. Linköping University, REMESO - Institute for Research on Migration, Ethnicity and Society.
    Is there evidence for the racialization of pharmaceutical regulation?: Systematic comparison of new drugs approved over five years in the USA and the EU2021In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 280, article id 114049Article in journal (Refereed)
    Abstract [en]

    Recent decades have seen much interest in racial and ethnic differences in drug response. The most emblematic example is the heart drug BiDil, approved by the US Food and Drug Administration in 2005 for "self-identified blacks." Previous social science research has explored this "racialization of pharmaceutical regulation" in the USA, and discussed its implications for the "pharmaceuticalization of race" in terms of reinforcing certain taxonomic schemes and conceptualizations. Yet, little is known about the racialization of pharmaceutical regulation in the USA after BiDil, and how it compares with the situation in the EU, where political and regulatory commitment to race and ethnicity in pharmaceutical medicine is weak. We have addressed these gaps by investigating 397 product labels of all novel drugs approved in the USA (n = 213) and the EU (n = 184) between 2014 and 2018. Our analysis considered statements in labeling and the racial/ethnic categories used. Overall, it revealed that many labels report race/ethnicity demographics and subgroup analyses, but that there are important differences between the USA and the EU. Significantly more US labels specified race/ethnicity demographics, as expected given the USAs greater commitment to race and ethnicity in pharmaceutical medicine. Moreover, we found evidence that reporting of race/ethnicity demographics in EU labels was driven, in part, by statements in US labels, suggesting the spillover of US regulatory standards to the EU. Unexpectedly, significantly more EU labels reported differences in drug response, although no drug was restricted to a racial/ethnic population in a manner similar to BiDil. Our analysis also noted variability and inconsistency in the racial/ethnic taxonomy used in labels. We discuss implications for the racialization of pharmaceutical regulation and the pharmaceuticalization of race in the USA and EU.

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  • 17.
    Nystedt, Paul
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Management and Economics, Economics and Economic History.
    Martial life course events and smoking behaviour in Sweden 1980-20002006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 6, p. 1427-1442Article in journal (Refereed)
    Abstract [en]

    The protective effect of marriage on smoking has been extensively established in the literature. However, less is known about the dynamics of how smoking behaviour is connected to various marital life course events, and whether there are any gender discrepancies in this respect. In this article the connection between the marital life course and smoking is analysed from a stress-related perspective controlling for other socio-economic characteristics. We use information on 81,000 individuals from the Swedish longitudinal micro-level ULF (Survey of Living Conditions) database 1980-2000, which is randomly drawn from the sample population of all Swedes aged 16-84. Logistic regressions on current smoking status and changes in smoking behaviour of participants in the panel part of the data are estimated. The marital life course is strongly linked to smoking behaviour with being or getting married indicating low smoking risks and marital disruption indicating high risks. The divorced smoke to a higher extent than the widowed and there are signs that getting divorced implies higher risks than becoming widowed, both of taking up/relapsing and, for women, not being able to quit. Further, the results indicate that the connection between smoking cessation and living with a partner is stronger for men, whereas women are more affected by the propensity to start smoking after marital disruption. The protective effect of being married on smoking decreases with the age difference between spouses in households where the wife is older than the husband. Taken together, the results yield a rather complex pattern of smoking behaviour over the marital life course. Further, perceived financial stress is strongly connected to smoking and not being able to quit. Controlling for this effect still leaves a socio-economic status gradient in smoking. © 2005 Elsevier Ltd. All rights reserved.

  • 18.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    The close relation between birth, abortion and employment rates in Sweden from 1980 to 20042006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 63, no 5, p. 1262-1266Article in journal (Refereed)
    Abstract [en]

    Birth and abortion rates in Sweden have fluctuated since 1980 while the proportion between the rates are the same at the beginning and end of the period. An increase in birth rates in the late 1980s resulted in a peak in 1991 and 1992, with 124,000 live births each year. Thereafter followed a steady decline in the rate until 2000, when the number of live births was about 90,000. At that point, the trend changed to an increase. The aim of this analysis was to investigate any relation between employment rates and the number of live births among women aged 20-34, and at the same time to explore the trend for abortion rates compared to the trend for live births. The relation between employment status and live birth rate is statistically more significant for women than men, and the rates have a higher correlation for the period after 1986. Young adults in this age group are vulnerable to economic cycles that can explain this covariation but the decline in birth rates in economically developed societies has multidimensional aspects and many other possible explanations. Much has been done in recent years in Sweden to decrease household inequality for families with children to avoid the risk of relative poverty, but the fact that there is no explicit health policy to reduce the abortion level that remain unchanged since the early 1980s may appear as a notable lack of strategy in a country with many other health-related goals. © 2006 Elsevier Ltd. All rights reserved.

  • 19.
    Shildrick, Margrit
    et al.
    Queens University, Belfast.
    Einstein, Gillian
    University of Toronto.
    The Postconventional Body: Retheorising Women's Health2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, no 2, p. 293-300Article in journal (Refereed)
    Abstract [en]

    We propose that women's health-both theory and practice-is a powerful arena in which to re-align and change the modernist theoretical underpinnings of current biomedical paradigms, which limit our understanding both of concepts of health and illness and of the impact of health care technologies on the body. We highlight the necessity of a move to a more dynamic paradigm for health and illness in the clinic, as well as a theoretical fluidity that allows for the real messiness of lived bodies. We argue that postmodernist thought, within wider feminist theory, is one of many perspectives that can contribute to contemporary biomedicine by providing theoretical underpinnings to develop 1) an understanding of bodies in context, 2) an epistemology of ignorance, and 3) an openness to the risk of the unknown. While these all entail a commitment to self-reflection and a willingness to be unsettled, which may not seem practical in the context of medical practice, we argue that self-reflection and unsettledness will provide pathways for grappling with chronic conditions and global bodies. Overall, we suggest that women's health practice can serve as a site in which both sides of the humanistic/scientific divide can engage with a human self in all its corporeal variety, contingency, and instability. More specifically, by providing a space within the clinic to examine underlying ontological, epistemological, and ethical assumptions, women's health can continue to contribute to new forms of biomedical practice.

  • 20.
    Siverskog, Jonathan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Henriksson, Martin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The health cost of reducing hospital bed capacity2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 313, article id 115399Article in journal (Refereed)
    Abstract [en]

    In the past two decades, most high-income countries have reduced their hospital bed capacity. This could be a sign of increased efficiency but could also reflect a degradation in quality of care. In this paper, we use repeated cross-sections on mortality and staffed hospital beds per capita in all 21 Swedish regions to estimate the potential death toll from reduced bed capacity. Between 2001 and 2019, mortality and beds decreased across all regions, but regions making smaller bed reductions experienced on average greater decreases in mortality, equivalent to one less death per three beds retained. This estimate is stable to a wide range of specifications and to adjustment for potential confounders, which supports a causal interpretation. Our results imply that by providing one more bed, Swedish health care could produce about three quality-adjusted life years (QALYs) at a cost of SEK 400,000 (∼US$40,000) per QALY. These findings could be informative about the marginal productivity of health care and support the credibility of empirical work attempting to estimate the opportunity cost of funding new healthcare interventions subject to a constrained budget.

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  • 21. Sätterlund-Larsson, Ullabeth
    et al.
    Säljö, Roger
    Aronsson, Karin
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute, Department of Child Studies.
    Patient-doctor communication on smoking and drinking. Life-style in medical consultations.1987In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 25, p. 1129-1137Article in journal (Refereed)
  • 22.
    Wahlstrom, R.
    et al.
    Wahlström, R., Department of Public Health Sciences, IHCAR, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
    Lagerlov, P.
    Department of Pharmacotherapeutics, University of Oslo, PO Box 1065 Blindern, NO-0316 Oslo, Norway.
    Stålsby, Lundborg C.
    Stålsby Lundborg, C., Department of Public Health Sciences, IHCAR, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
    Veninga, C.C.M.
    Department of Clinical Pharmacology, Northern Centre for Health Care Research, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, Netherlands.
    Hummers-Pradier, E.
    Department of General Practice, University of Göttingen, Robert-Koch-Str 42, D-37075, Germany.
    Dahlgren, Lars-Ove
    Linköping University, Faculty of Educational Sciences. Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education.
    Denig, P.
    Department of Clinical Pharmacology, Northern Centre for Health Care Research, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, Netherlands.
    Variations in general practitioners' views of asthma management in four European countries2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 53, no 4, p. 507-518Article in journal (Refereed)
    Abstract [en]

    The aim was to identify differences and similarities in views regarding asthma management among general practitioners in four European countries (Germany, Netherlands, Norway and Sweden), and to explore reasons for sub-optimal performance. The results are to be used for the development and tailoring of educational interventions. Semi-structured interviews with 20GPs in each country were conducted and analysed using a phenomenographic approach. The domains of (i) general view of asthma, (ii) the doctor-patient relationship in managing asthma, and (iii) overall management of asthma (treatment goals and evaluation of results) were approached during the interviews. There were different ways of experiencing phenomena related to asthma management both within and between the four countries. Three general views on asthma were found where different perspectives were emphasised: a medical, a 'global' (including community health, social and environmental aspects) and a patient's perspective. Within the medical perspective, only a few German doctors emphasised a psychological aetiology of asthma. The views on the doctor-patient relationship described as 'authoritarian', 'teaching' or 'empowering' occurred similarly in all countries. The majority of the doctors showed confidence in the effectiveness of the pharmaceutical treatment of asthma, some doctors were concerned about limitations, but only in Germany a few doctors were explicitly critical of the values of conventional pharmaceutical treatment. The main treatment goals were either conceived as getting the patient symptom-free (Netherlands, Norway, and Germany) or to control the inflammatory process (Sweden). Several German and some Norwegian doctors expressed the view that patients had to accept the disease and learn how to manage it, while a few German doctors aimed at alternative treatments of asthma. The existence of qualitatively different ways of experiencing asthma management, both in and between countries, calls for consideration when trying to implement general evidence-based treatment guidelines. A variation of approaches in continuing medical education for GPs is needed to address such existing beliefs and conceptions that could sometimes be opposed to the content of educational messages. Copyright © 2001 Elsevier Science Ltd.

  • 23.
    Åsbring, Pia
    et al.
    Institutionen för Folkhälsovetenskap KI.
    Närvänen, Anna-Liisa
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Thematic Studies.
    Ideal versus reality: Physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia2003In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 57, no 4, p. 711-720Article in journal (Refereed)
    Abstract [en]

    Encountering patients with chronic fatigue syndrome (CFS) or fibromyalgia can cause dilemmas for physicians due to the uncertainty inherent in these illnesses. The aim of this study was to investigate: (1) How physicians in a Swedish sample describe and categorise patients with CFS and fibromyalgia, (2) What the character of CFS and fibromyalgia, with regard to diagnosing, treatment and medical knowledge/aetiology, mean to the physicians in encounters with patients, and (3) Which strategies physicians describe that they use in the encounter with these patients. Semi-structured interviews were carried out with 26 physicians, specialists in various fields who all had some experience of either CFS or fibromyalgia. The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients. This may lead to the professional role being questioned. Different strategies are developed to handle the encounters with these patients. The results also illuminate the physician's interpretations of patients in moralising terms. Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status. Scepticism was expressed regarding especially CFS, but also fibromyalgia. Moreover, it is shown how the patients are characterised by the physicians as ambitious, active, illness focused, demanding and medicalising. The patient groups in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases. ⌐ 2003 Elsevier Science Ltd. All rights reserved.

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