Association between levels of pentraxin 3 and incidence of chronic kidney disease in the elderly

OBJECTIVE: Higher levels of the novel inflammatory marker pentraxin 3 (PTX3) predict cardiovascular mortality in patients with chronic kidney disease (CKD). Yet, whether PTX3 predicts worsening of kidney function has been less well studied. We therefore investigated the associations between PTX3 levels, kidney disease measures and CKD incidence. METHODS: Cross-sectional associations between serum PTX3 levels, urinary albumin/creatinine ratio (ACR) and cystatin C-estimated glomerular filtration rate (GFR) were assessed in two independent community-based cohorts of elderly subjects: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, n = 768, 51% women, mean age 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 651, mean age 77 years). The longitudinal association between PTX3 level at baseline and incident CKD (GFR <60 mL( ) min(-1)  1.73 m(-) ²) was also analysed (number of events/number at risk: PIVUS 229/746, ULSAM 206/315). RESULTS: PTX3 levels were inversely associated with GFR [PIVUS: B-coefficient per 1 SD increase -0.16, 95% confidence interval (CI) -0.23 to -0.10, P < 0.001; ULSAM: B-coefficient per 1 SD increase -0.09, 95% CI -0.16 to -0.01, P < 0.05], but not ACR, after adjusting for age, gender, C-reactive protein and prevalent cardiovascular disease in cross-sectional analyses. In longitudinal analyses, PTX3 levels predicted incident CKD after 5 years in both cohorts [PIVUS: multivariable odds ratio (OR) 1.21, 95% CI 1.01-1.45, P < 0.05; ULSAM: multivariable OR 1.37, 95% CI 1.07-1.77, P < 0.05]. CONCLUSIONS: Higher PTX3 levels are associated with lower GFR and independently predict incident CKD in elderly men and women. Our data confirm and extend previous evidence suggesting that inflammatory processes are activated in the early stages of CKD and drive impairment of kidney function. Circulating PTX3 appears to be a promising biomarker of kidney disease.

Värdigt liv och välbefinnande, enligt vem? : en kvalitativ studie om brukare och biståndshandläggares beskrivningar av ett värdigt liv och välbefinnande : Dignity and well-being, according to whom? : a qualitative study of elderly and assistance officer´s descriptions of a dignified life and wellbeing

We are two students named Susanne Grönlund and Anna Zaar and have jointly worked together this c-essay called "dignity and well-being according to whom? The paper is written at Högskolan dalarna in Falun.The purpose of this study was to investigate how the elderly and assistance officer describes dignity and well-being and how it is consistent with the government's bill on the national values that the National Board has developed.Our empirical study consists of four qualitative interviews, two older people dependent on community care and two assistance officers. The study's theoretical basis is Antonovsky's salutogenic approach and SOC. The survey focuses on different themes such as dignity, integrity, participation, treatment, wellbeing, security and meaningfulness which are also central themes in the Government Bill on the national values for elderly.The results show that the respondents believe that a life of dignity is difficult to define and also a subjective experience. The results also show a consistency between what the elderly, assistance officer and the national values that define dignity and well-being. Social Services Act, national values should serve as a starting point for municipalities to improve elderly care, thereby creating a sense of coherence for the individual. Keywords: Elder care, dignity, integrity, participation, attitude, well-being, security and meaningfulness.

The impact of big-boxes on local retail : What happens when IKEA comes to town?

The development of large discount retailers, or big-boxes as they are sometimes referred to, are often subject to heated debate and their entry on a market is greeted with either great enthusiasm or dread. For instance, the world’s largest retailer Wal-Mart (Forbes 2014) has a number of anti- and pro-groups dedicated to its being and the event of a Wal-Mart entry tends to be met with protests and campaigns (Decamme 2013) but also welcomed by, for instance, consumers (Davis & DeBonis 2013). Also in Sweden, the entry of a big box is a hot topic and before IKEA’s opening i Borlänge 2013, the first in Sweden in more than five years, great expectations were mixed with worry (Västerbottens-Kuriren 2011).The presence of large scale discount retailers is not, however, a novel phenomenon but a part of a long-term change in retailing that has taken place globally over the past couple of decades (Taylor & Smalling, 2005). As noted by Dawson (2006), the trend in Europe has over the past few decades gone towards an increasing concentration of large firms along with a decrease of smaller firms.This trend is also detectable in the Swedish retail industry. Over the past decade, the retailing industry in Sweden has increased by around 190 Billion SEK, and its share of GDP has risen from 2,7% to 2,9%, while the number of employees have increased from 200 000 to 250 000 (HUI 2013). This growth, however, has not been distributed evenly but rather it has been oriented mainly towards out-of-town retail clusters. Parallel to this development, the number of large retailers has risen at the expense of market shares of smaller independent firms (Rämme et al 2010). Thereby, the presence of large scale retailers is simply part of a changing retail landscape.The effects of this development, where large scale retailing agents relocate shopping to out-of-town shopping areas, have been heavily debated. On the one hand, the big-boxes are accused of displacing independent small retail businesses in the city-centers and the residential areas, resulting in, to some extent, reduced employment opportunities and less availability for the consumers - especially the elderly (Ljungberg et al 2006). In addition, as access to shopping now tends to require some sort of a motorized vehicle, environmental aspects to the discussion have emerged. Ultimately these types of concerns have resulted in calls for regulations against this development (Olsson 2010). On the other hand, the proponents of the new shopping landscape argue that this evolution implies productivity gains, the benefits of lower prices and an increased variety of products (Maican & Orth 2012). Moreover it is argued that it leads to, for instance, better services (such as longer opening hours) and a creative destruction transformation pressure on retailers, which brings about a renewal of city-centerIIretail and services, increasing their attractivity (Bergström 2010). The belief in benefits of a big box entry can be exemplified by the attractivity of IKEA, and the fact that municipalities are prepared to commit to expenses amounting up to hundreds of millions in order to attract the entry of this big-box. Borlänge municipality, for instance, agreed to expenses of about 350 million SEK in order to secure the entry of IKEA, which opened in 2013 (Blomgren 2009).Against this backdrop, the overall effects of large discount retailers become important: Are the economic benefits enough to warrant subsidies or are there, on the contrary, some very compelling grounds for regulations against these types of establishments? In other words; how is overall retail in a region where a store like IKEA enters affected? And how are local retail firms affected?In order to answer these questions, the purpose of this thesis is to study how entry of a big-box retailer affects the entry region. The object of this study is IKEA - one of the world’s largest retailers, with 345 stores, active in over 40 countries and with profits of about 3.3 billion (IKEA 2013; IKEA 2014). By studying the effects of IKEA-entry, both on an aggregated level and on firm level, this thesis intends to find indications of how large discount retail establishments in general can be expected to affect the economic development both in a region overall, but also on the local firm level, something which is of interest to both policymakers as well as the retailing industry in general.The first paper examines the effects of IKEA on retail revenues and employment in the municipalities that IKEA chose to enter between 2000 and 2011; Gothenburg, Haparanda, Kalmar and Karlstad. By means of a matching method we first identify non-entry municipalities that have a similar probability of IKEA entry as the true entry municipalities. Then, using these non-entry municipalities as a control group, the causal effects of IKEA entry can be estimated using a treatment-control approach. We also extend the analysis to examine the spatial impact of IKEA by estimating the effects on retail in neighboring municipalities. It is found that a new IKEA store increases revenues in durable goods trade with 20% in the entry municipality and the number of employees with 17%. Only small, and in most cases statistically insignificant, negative effects were found in neighboring municipalities.It appears that there is a positive net effect on durables retail sales and employment in the entry municipality. However, the analysis is based on data on an aggregated municipality level and thereby it remains unclear if and how the effects vary within the entry municipalities. In addition, the data used in the first study includes the sales and employment of IKEA itself, which could account for the majority of the increases in employment and retail. Thereby the potential spillover effects on incumbent retailers in the entry municipalities cannot be discerned in the first study.IIITo examine effects of IKEA entry on incumbent retail firms, the second paper in this thesis analyses how IKEA entry affects the revenues and employment of local retail firms in three municipalities; Haparanda, Kalmar and Karlstad, which experienced entry by IKEA between 2000 and 2010. In this second study, we exclude Gothenburg due to the fact that big-box entry appears to have weaker effects in metropolitan areas (as indicated by Artz & Stone 2006). By excluding Gothenburg we aim to reduce the geographical heterogeneity in our study. We obtain control municipalities that are as similar as possible to the three entry municipalities using the same method as in the previous study, but including a slightly different set of variables in the selection equation. Using similar retail firms in the control municipalities as our comparison group, we estimate the impact of IKEA entry on revenues and employment for retail firms located at varying distances from the IKEA entry site.The results generated in this study imply that entry by IKEA increases revenues in incumbent retail firms by, on average, 11% in the entry municipalities. In addition, we do not find any significant impact on retail revenues in the city centers of the entry municipalities. However, we do find that retail firms within 1 km of the IKEA experience increases in revenues of about 26%, which indicates large spillover effects in the area nearby the entry site. As expected, this impact decreases as we expand the buffer zone: firms located between 0-2 km experiences a 14% increase and firms in 2-5 km experiences an increase of 10%. We do not find any significant impacts on retail employment.

Inflammation, oxidative stress, glomerular filtration rate, and albuminuria in elderly men : a cross-sectional study

BACKGROUND: The role of inflammation and oxidative stress in mild renal impairment in the elderly is not well studied. Accordingly, we aimed at investigating the associations between estimated glomerular filtration rate (eGFR), albumin/creatinine ratio (ACR), and markers of different inflammatory pathways and oxidative stress in a community based cohort of elderly men. FINDINGS: Cystatin C-based GFR, ACR, and biomarkers of cytokine-mediated inflammation (interleukin-6, high-sensitivity C-reactive protein[CRP], serum amyloid A[SAA]), cyclooxygenase-mediated inflammation (urinary prostaglandin F2alpha [PGF2alpha]), and oxidative stress (urinary F2 isoprostanes) were assessed in the Uppsala Longitudinal Study of Adult Men(n = 647, mean age 77 years). RESULTS: In linear regression models adjusting for age, BMI, smoking, blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, and treatment with statins, ACE-inhibitors, ASA, and anti-inflammatory agents, eGFR was inversely associated with CRP, interleukin-6, and SAA (beta-coefficient -0.13 to -0.19, p < 0.001 for all), and positively associated with urinary F2-isoprostanes (beta-coefficient 0.09, p = 0.02). In line with this, ACR was positively associated with CRP, interleukin-6, and SAA (beta- coefficient 0.09-0.12, p < 0.02 for all), and negatively associated with urinary F2-isoprostanes (beta-coefficient -0.12, p = 0.002). The associations were similar but with lower regression coefficients in a sub-sample with normal eGFR (>60 ml/min/1.73 m2, n = 514), with the exception that F2-isoprostane and SAA were no longer associated with eGFR. CONCLUSION: Our data indicate that cytokine-mediated inflammation is involved in the early stages of impaired kidney function in the elderly, but that cyclooxygenase-mediated inflammation does not play a role at this stage. The unexpected association between higher eGFR/lower albuminuria and increased F2-isoprostanes in urine merits further studies.

Carers in the welfare state : on informal care and support for carers in Sweden

  The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that 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 than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

Äldre och psykofarmaka : Några sjuksköterskors uppfattning

Nearly nine percent of the population in Sweden are 75 years or older. Still they consume more than a quarter of all medicines. This increased use, is specially noticeable in nursing home residents, where the elderly is using a average of 8-10 preparations per day. According to the National Board of Health and Welfare in Sweden, the number of drugs and specially psychotropic drugs, has proved to be a risk factor for drug-related problems among the elderly, such as drug interaction and side effects. Routines for regular and systematic follow-up of drug prescription and utilisation reviews were not extensively implemented. According to the National Board of Health and Welfare its important to start the work to reduce psychotropic drugs among the elderly in nursing homes. Aim: This studie examine nurses apprehension about psychotopic drugs among the elderly in nursing homes. Method: An questionnarie based survey whit 10 closed questions. The questionary was answered of 46 nurses who works in nursing homes. Result: A majority of the nurses, tought the elderly in nursing homes were using to musch psychotropic drugs. The nurses tought that psychotropic drugs often prescribes as a matter of routin, particullary hypnotics and sedeativs. Those drugs was not effectiv in long terms according to the nurses. They also tought that alternative mehtods should be considered before describing pscyhotropic drugs. The nurses tought as a occupational group, that they had a responsibility to follow up and evaluate the elderlys medication whit psychotropic drugs.

Validering av Alberta Context Tool (ACT) för bruk inom svensk kommunal äldrevård : Ett verktyg för implementering av evidensbaserad vård

The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups. The majority of LPNs expressed that it was easy to respond to the questions (56%), while nine percent considered it as difficult. Eleven comments were given about questions that were perceived to be unclear, complicated or contained difficult words. In the RN group only 30 percent considered that the questions were easy to respond to. One third of the RNs considered that part of the questions were unclear, and six RNs expressed also which questions they experienced as unclear. In general, the questions in the ACT were perceived as relevant. The instrument's relevance as a tool to measure contextual factors that influence the implementation of evidence based nursing can also be considered to be determined. By modifying the content in the questionnaire in accordance with what appeared in this survey and to implement yet another test, the instrument should be considered to be relevant for use within Swedish municipality care of the elderly. ACT can be used both as a tool in the work on improvement of clinical practice and as a tool for further research about implementation of evidence based nursing.

Besökshundens påverkan på arbetssituationen inom den särskilda omsorgen

This essay is about dogs that visit is used, whitin care of elderly. The dogs found caretakers once a week and one hour at a time. The focus has been placed on the dogs that go to the municipality's special accommodation and the research was done in a medium-sized municipality in Sweden. The focus of the narrowing of the work was done to the work situation for care staff to assess the impact of the visits the dogs presence. It was distributed questionnaires answered by care staff in which it concluded their visit to the dog's presence felt and how it impacted the situation. There has been much previous research done on how dogs affect the elderly in care. This has been done to see if the care staff perceive the same thing, and in turn experience any possible help of visiting dogs. What emerged in this study is that most are in favor of visits dog and they're older. The majority of respondents agreed that their work situation has become neither better nor worse then visit the dogs started to meet caretakers. This may be due to visit the dog is not enough time on site at each visit. Even the fact that care staff are not practicing with the caretakers memory to get them to remain in the state of mind that research shows that the older gets in. These can have an impact on how care staff perceive a possible means in visits of the dog.

En meningsfull tillvaro för den äldre människan : En litteraturöversikt

Syfte; Syftet med denna litteraturöversikt var att beskriva upplevelsen av vad som skapar en meningsfull tillvaro samt hur sjuksköterskan kan stödja och främja en meningsfull tillvaro för de äldre vid särskilda boenden. Metod; Studien genomfördes som en litteraturöversikt. Artiklar publicerade mellan åren 2000-2012 söktes i databaserna CHINAL, ELITE, PubMed, SweMed samt i tidskriften Vård i Norden. Resultat; Resultatet visade på att upprätthållandet av kroppens fysiska och mentala förmågor hade stor inverkan för den upplevda hälsan. Social gemenskap, goda vårdrelationer och ett aktivt delagande i den egna vardagen ansågs även placera den äldre i ett sammanhang, vilket också grundade för meningsfullhet och välbefinnande. Konklusion; För att uppnå en god omvårdnad av de äldre krävdes sjuksköterskor med ett stort kunnande och engagemang där goda omvårdnadsrelationer skapades utifrån den enskildes livsberättelse, behov och önskningar.

Sjuksköterskors upplevelse av läkemedelshantering till äldre i kommunal hälso– och sjukvård : En kvalitativ studie

Syfte: Syftet med studien var att beskriva hur sjuksköterskor inom den kommunala hälso – och sjukvården upplevde läkemedelshantering till äldre. Metod: Studien hade en kvalitativ design och data samlades in med enskilda intervjuer av fem sjuksköterskor och analyserades med hjälp av innehållsanalys enligt Graneheim och Lundman. Resultat: Dataanalysen resulterade i fyra teman med underliggande kategorier. De teman som framkom var: Sjuksköterskan har en betydelsefull roll, att ha insikt och kompetens om äldres läkemedelsanvändning, att anpassa behandlingen till patientens förutsättning och att ha en fungerande verksamhet.  Resultatet visade att det fanns en ökad medvetenhet kring läkemedelsbehandling till äldre men det behövdes mer utbildning inom området. Att ha en fungerande verksamhet ansågs viktigt och det var betydelsefullt att ha ett bra samarbete med andra. Det upplevdes positivt med läkemedelsgenomgångar och i resultatet framkom att sjuksköterskorna tog ett stort ansvar för kvaliteten, var uppmärksamma och följde upp läkemedelsbehandlingar. Att anpassa läkemedelsbehandlingen till patientens förutsättningar ansågs viktigt för att undvika läkemedelsrelaterade problem. Det framgick av resultatet att läkarkontinuitet underlättade arbetet för sjuksköterskorna och höjde kvaliteten på äldres läkemedelsanvändning. Det fanns ett önskemål om en geriatriker inom verksamheten då en del sjuksköterskor upplevde att allmänläkarna saknade kunskap om läkemedelsbehandling till äldre.  Slutsats: Sjuksköterskan har en viktig roll och tar ett stort ansvar för läkemedelbehandlings kvalitet. Att anpassa läkemedelsbehandlingen till patientens förutsättningar är viktigt för att undvika läkemedelsrelaterade problem. Det finns ett behov av ökad kompetens inom området bland alla yrkesgrupper. Det är angeläget med ökad bemanning och god läkarkontinuitet i verksamheten för att höja kvaliteten på läkemedelsbehandlingen.

Medierepresentationer av etnicitetsochmigrationsrelaterade frågor inomäldreomsorgen i Sverige och Finland

Media representations of ethnicity- and migration-related issues within the elderly care in Sweden and Finland Research on welfare regimes and migration regimes has shown that Sweden and Finland have similar elderly care regimes but different migration regimes. It is against this backdrop that we set out to study what Swedish and Finnish daily press focusing on elderly care has written about ethnic minorities, migrants and migration. The study uses quantitative content analysis to analyze 241 daily newspaper articles published between 1995 and 2008. This article presents the themes that have been discussed, the elderly care actors that have been in focus (i.e. whether the focus has been on elderly care recipients, elderly care providers or informal caregivers), the ethnic backgrounds that these actors have had (i.e. whether the focus has been on the ethnic majority or on ethnic minorities) and the type of explanatory frameworks that the newspaper articles in focus have used. On the basis of this, we problematize the representations of ethnic minorities, migrants and migration that the newspaper articles in question put forth and the fact that the Swedish and Finnish daily press treats the issues at hand as if migration is mostly an issue that can be relegated to the periphery of the elderly care sectors’ agenda. 

Konsensus och personifierade konflikter : problembeskrivningar av äldreomsorg i svensk dagspress

Consensus and personified conflicts: representations of elderly care issues in Swedish newspapers Elderly care issues are commonly framed in public discourse. In mass media the representations of such issues are influenced by media logic. The purpose of this paper is to describe and analyse how elderly care issues were represented in three Swedish newspapers during the first half of 2007. How were the problems characterized? How were different actors characterized and which roles were they assigned? How are conflicts of interests described? Finally, we aim to discuss how media contribute to an understanding of the complexity of elderly care as a whole. Taken together, the articles do not provide a coherent picture. However, costs, quality of care and demographic issues were common themes. The elderly were commonly represented in personal narratives about problems that occurred when they needed elderly care. The elderly in the future are projected as more active and demanding than the elderly today. The care workers were active voices in discussions about working conditions, but absent in discussions about their education and professional identity, which was an issue commonly advocated by politicians. Many issues were represented as conflicts between the individual elderly and the care system or between care workers and their employers. More elaborated discussions about how to prioritize between different needs and demands were rare. This can be seen as examples of how the media tends to use personification, simplification and polarization as means to tell interesting stories.

After work : en longitudinell studie i arbetsmiljöns långsiktiga inverkan på sambandet mellan socioekonomisk position och äldres ohälsa

After Work. The long-term effects of work environment on the association between adult socioeconomic position and ill health among the elderly The aim of this study is to analyse the long-term effects of work environment on the association between adult socioeconomic position (SEP) and six ill health outcomes among the elderly. Data was drawn from the longitudinal Level of Living and the SWEOLD-surveys. The individuals are followed from 1968 to 1992 and from 1981 to 2002 and 2004, combining baseline information regarding SEP and work environment during the period of occupational activity with the ill health outcomes from the follow-up studies. Strongest effects where revealed when controlling for the physical work environment on the association between both measures of SEP and two of the ill health outcomes: musculoskeleta lpain and physical performance. The psychological work environment, however, explained very small parts of the associations. The results, even controlled for SEP, exposed strong direct relations between ill health and psychological work environment and rather strong relations to physical work environment. As socioeconomic position indicates a particular structural position within society it may determine the likelihood of health damaging exposures during the period of occupational activity. This study shows that the effect of work environment significantly affects ill health among the elderly. Hence, the results indicate the importance of taking measures in improving work environment during the labour-market participation period, especially since policy-makers attempt to convince workers to stay longer in the workforce.

Attraktivt arbete i offentlig sektor bland enhetschefer inom vård och omsorg

HR-funktionens uppgift i en organisation är att tillvarata den mänskliga resursen och se till att goda arbetsförhållanden uppnås. Detta för att kunna attrahera, rekrytera, behålla och utveckla kompetens (Kira 2003). På senare år har arbetsförhållanden och arbetsvillkor uppmärksammats på kommuner i Sverige för bland annat enhetschefer i äldreomsorgen. Arbetsförhållandena, arbetsvillkoren och framför allt den höga personalomsättningen bland dessa, har lett till en problematik som var en av valets viktigaste frågor 2014. Syftet med denna studie är att beskriva arbetsförhållanden för enhetschefer inom mindre kommuner i Sverige, inom den sociala sektorn och belysa hur dessa skulle kunna förbättras. Som studieobjekt har Orsa kommun använts. Resultatet av undersökningen visade att arbetssituationen för enhetschefer är övermäktig, då det är hög arbetsbelastning samt dålig struktur i arbetet. Enhetscheferna själva skulle gynnas av en assistent samt en arbetsbeskrivning för att minska arbetsbelastningen och få struktur i arbetet. Vår slutsats är att kommuner i Sverige borde arbeta med att skapa bättre arbetsförhållanden för enhetschefer samt arbeta för att underlätta arbetsbördan. Vårt förslag till Orsa kommun är att ta hjälp av vår handlingsplan och därmed anställa assistenter till enhetscheferna samt skapa arbetsbeskrivningar. Vidare forskning i ämnet skulle kunna belysa mentorskapets betydelse i den offentliga sektorn inom kommuner i Sverige samt organisationsstrukturens bemärkelse för arbetets attraktivitet.

Äldre och ensamhet : En kartläggning av sociala insatser för äldre personer i Dalarnas kommuner

Det finns begränsat med forskning kring hur biståndshandläggare inom äldreomsorgen arbetar med ensamhet hos äldre personer. Med anledning av detta är studiens huvudsakliga syfte att undersöka hur biståndshandläggare i Dalarnas kommuner arbetar med att utreda sociala behov till följd av ensamhet hos äldre personer samt att ta reda på vilka kommunala sociala insatser som erbjuds för dessa individer och på vilka grunder. Studien är genomförd utifrån en kvantitativ ansats, där vi har använt oss av en enkät, som innehåller frågor som avser att besvara syftet. Tolkningsramen för analysen av det empiriska materialet utgörs av Lipskys teori om gräsrotsbyråkrati. Studiens resultat visar att det finns behov av att både utöka och utveckla kommunernas utbud av sociala insatser för äldre personer samt att utveckla rutiner för hur man ska arbeta med ensamhet hos äldre personer. Studien påvisar ett behov av mer forskning, både internationell och nationell, kring hur biståndshandläggare arbetar med att identifiera ensamhet hos äldre personer.