Non-take up i det svenska välfärdssystemet : Om betydelsen av social position för kvinnors beslut kring mammografiscreening

Non-take up in the Swedish welfare system: On the impact of social position on women’s decision-making regarding mammography screening Central to a well-functioning and effective welfare system is that benefits reach the people to whom they are intended. By focusing on an example of so called non-take up – namely women’s decision not to attend mammography screening – this article discusses decision making in relation to living conditions, i.e. social position, and to the public health intentions of the welfare state. The main theoretical basis for the analysis is Rogers’ humanistic/existential theory. Qualitative semi-structured interviews were made with 18 women who had abstained from mammography screening. Their decision was described, analyzed and problematized focused on whether their living conditions, leading to a strong or weak social position, is of relevance to their decision to refrain from this health promoting examination. The women’s own experiences clearly showed how their social position was of great importance for how they explained their decision to abstain. Furthermore, social position affects how women handle different impact from living conditions, society’s expectations and personal experiences of mammography screening. This study makes visible the gap between public health intentions of the society and individual conditions.  

Screening av nutritionsstatus hos kritiskt sjuka : en systematisk litteraturstudie

Syftet med denna studie var att kartlägga screeningsinstrument som mäter nutritionsstatus hos kritiskt sjuka samt se hur de används i vården. Studien genomfördes som en systematisk litteraturstudie. Artiklar söktes i databaserna Cinahl och Medline. Tretton artiklar identifierades, efter kvalitetsgranskning, till studien. I resultatet framkom flera nutritionsscreeningsinstrument och tre utav dessa; SGA, MUST och NRS 2002, var mer anpassade för screening av kritiskt sjuka. NRS 2002 hade av dessa tre högst specifitet, då instrumentet bedömer sjukdomens eller skadans svårhetsgrad som en risk för undernäring. Resultaten om hur screeningsinstrumenten används i vården visar att användandet av dessa instrument var sällsynt, rekommendationer följs inte. Orsaker till det är bland annat personalens attityder och kunskapsbrist, ansvarsfördelning och rutiner. Några sjuksköterskor föredrog att använda sig av egna bedömningar av patienternas nutritionsstatus. I studier där nutritionsförbättringsprojekt införts ökade nutritionsscreeningen och dokumentationen signifikant. Slutsatsen är att NRS 2002 är det nutritionsscreeningsinstrument som passar bäst för kritiskt sjuka. Screeningsinstrumenten används dock inte som rekommenderat och orsaker till det är bland annat personalens kunskapsbrist och attityder.

No consensus on gestational diabetes mellitus screening regimes in Sweden : pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Background: Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values. Methods: This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184, 183 women: 88, 140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed. Results: Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m(2). Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes. Conclusions: There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.