Background. Samis are indigenous people in north Europe. In the territory called Sapmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health. Methods. The study examines relations between the level of SOC and background factors from surveys in a Sami population (n = 613) in comparison to a non-Sami population (n = 525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders. Results. There are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders. Conclusions. In addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community.
Problem: The study explores predictors of homelessness in Swedish municipalities and of the amount of accommodations provided to the homeless. Theoretically, structural factors (e.g. housing market) and individual factors (e.g. social and health factors) have competed in theories explaining homelessness. Here, the focus is not on individuals, but rather the aggregated levels of such problems. Methods: Homelessness rates were collected in a national inventory (NBHW 2006.) and data on municipal support provisions were collected in a representative sample of half of the Swedish municipalities. Candidate explaining factors of homelessness studied here are variables related to urbanisation, economy of the municipality, various housing market factors, level of social and health problems and demographic factors. Level of homelessness and political majorities are also used as predictors of provisions. Results: Homelessness rate (per 10 k inhabitants) is predicted (R2= .36) by urbanisation (no of inhabitants), market (rent level) and level of psychiatric health problems in the municipality. Amount of accommodations (per 10 k inh.) is predicted (R2= .18) by homelessness rate, social welfare costs and structure of housing market, i.e. greater public owned sector in normal housing. Conclusions: Structural factors and level of individual problems both add to the explanation of homelessness. In addition, degree of urbanisation seems to be an additional factor. This however, may in turn indicate more specific factors not studied here. The amount of accommodations per inh. is, as expected, related to the level of homelessness and the level of social problems in the municipality. Additionally, the structure of the housing market seems to have important impact on the amount of provisions, independent of problem levels.
This paper discusses special category housing for homeless addicts, based on case studies of two different housing programmes, using both qualitative and quantitative data. The staff and residents were interviewed about their experiences of the programmes. Longitudinal data was collected on various indicators of substance misuse and the frequency of contact with the social services at different levels. Our findings show that the special category housing has positive direct effects on the housing stability of the residents and their feelings regarding their quality of life, but not on their substance misuse. However, the increased housing stability seems to be more a direct effect of them staying on the programme, rather than a long-term effect. Furthermore, although their quality of life improves, the residents still experience a lack of belonging and that their lives lack a meaningful content. The choice of special category housing as an intervention model thus seems to perpetuate rather than prevent social exclusion and can possibly be described as an expression of institutionalised resignation
This article explores key predictors of homelessness rates in different Swedish munici-palities, the accommodation provided and the coverage of accommodation to homeless-ness. In order to create realistic models, seven sets of factors represent various structural levels in stepwise regressions. These sets are urbanisation, economy, demographic com-position, housing market, aggregated individual problems, political majority and policies and organisational features of the social services. The findings show that urbanization is central to understanding variations in homelessness and has also impact on housing pro-visions. In addition, higher rent levels as well as aggregated psychiatric problems seem to increase the level of problems. Overall supply of apartments and the proportion of public housing are important factors in providing accommodation, and a demographic factor, such as the proportion of single-parent households, seems to enhance such a provision. Political majority as well as the functional organization of the social services seems to independently impact coverage rates. Despite the importance of urbanization, findings indicate that a number of factors with impact on the problem and on the possibilities to handle them are manageable by the municipalities. Key words: predicting homelessness, accommodation, housing provisions, local author-ity, social services.
This study is based on a nationwide survey of local Muslim congregations (n = 105) and focuses on the patterns and function of voluntary social work carried out by the congregations.Muslim congregations in Sweden are not only religious meeting places, but also social meeting places and centres for the organisation of a broad range of social welfare services: outreach activities, support to newly arrived immigrants and activities for children and young people. The work is carried out on a voluntary basis at the intersection between the congregation and the community. Muslim voluntary social work appears to be most intensive in smaller municipalities with a large amount of unemployment. The dominant discourse on Islam in Europe has claimed that Muslim social work is part of an attempt to create self-sufficient enclaves that impede the integration of Muslim immigrants into the wider society. Claims of this type seem, however, to be largely unfounded. The Swedish Muslim congregations that carry out the most voluntary social work are those most interested in co-operation with other organisations and with authorities of different types and those that have the most positive experiences of the wider society.
The aim of the study is to examine the extent to which Muslim congregations in Sweden cooperate with organizations in the public and voluntary sectors and to identify the internal and external organizational factors that favour or disfavour such cooperation. The study is based on a nationwide survey of local Muslim congregations (n = 105), and is the first survey of its kind in Europe. Like many other voluntary organizations, Muslim congregations work in cooperation with other voluntary organizations, but also with various institutions run by the local authorities. In Sweden, cooperation between different organizations is strongly encouraged, which results in a system that provides the congregations with opportunity structures. Other factors that influence the degree of cooperation include whether the congregation feels support or opposition from the surrounding community and the local demographic and socio-economic situation: there is a higher degree of cooperation in small municipalities with many social problems. Ethnic heterogeneity is one of the major organizational factors that affect the degree of cooperation. congregations that have an open attitude towards different Muslim traditions, which essential for a multiethnic congregation, are also those most interested in cooperation with other organizations and institutions. Irrespective of whether they belong to a national umbrella organization or not, Muslim congregations in Sweden are in priciple independent local organizations. It is therefore difficult for Islam in Sweden to operate on a national level, in the way that other more established voluntary organizations do. On the other hand, this study shows that while they lack a united voice on the national arena, they have the advantage of flexibility arising from their local autonomy.
Islam is the fastest growing religion in Western Europe today. As a consequence, the emergence and growth of Muslim religious congregations is one of the most important changes that have taken place within the European third (or voluntary) sector in the last 20 years. However, more often than not, these congregations are described as "enclaves" or "integration traps" isolating new citizens from the rest of society, a picture that has remained largely uncontested due to a lack of more extensive research.
Beskrivning, användning, tillförlitlighet och normer
The Swedish National Board on Health and Welfare recommends that structured assessment instruments should be used in medical as well as in social treatment of substance misusers. These should be validated in a Swedish context. Instruments for diagnoses of dependence/abuse (DSM-IV) and dependence/harmful use (ICD-10) have been used in Sweden for many years, although not yet validated in Swedish. ADDIS, the Swedish version of the American SUDDS, is used in four Nordic countries and the most often used diagnostic instrument in Sweden. This article investigates the psychometric properties of ADDIS alcohol module, including discriminant and construct validity and internal consistency. The two main constructs in DSM - dependence and abuse - as well as the seven criteria for dependence and the four criteria for abuse are studied. Further, the value of each of the 44 specific items in ADDIS for capturing these criteria is studied.
Two samples are explored: 1) a clinical sample (n = 349; incl. 129 women) and 2) a sample of 400 men convicted for driving while intoxicated. Mean age was the same (41 ys.). Using discriminant analyses on lifetime prevalence, the items correctly classify 94% of the cases in the two samples. Using one-factor principal component analysis to explore homogeneity of the combined samples, all 28 items on dependence and 15 of 18 items on abuse have loadings above 0,40 (R2 dependence = 0,46; abuse = 0,40). Separate analyses of the two samples, as well as on women, show similar results. Cronbach's alpha is excellent for dependence and satisfactory for abuse in all analyses. Analyses of specific criteria show satisfactory results on dependence and acceptable on abuse. Minor revisions are proposed to make ADDIS more user-friendly and to improve some specific items.
In conclusion: ADDIS has acceptable to excellent discriminant and construct validity as well as internal consistency and captures the specific criteria of DSM-IV. It has the preconditions for sensitive assessment of alcohol use disorders in men and women.
Compulsory treatment for alcoholism and drug addiction exists in many countries, but has been less evaluated. For legal and ethical reasons, controlled designs are scarce. The Swedish �Law on Care for Addicts in certain cases� was implemented in 1982, and revised 1989. Since 1982, twenty outcome studies using different research design have been published, mostly in Swedish. The presentation reviews these studies. Outcomes of men vs. women, alcoholics vs. drug addicts and compulsorily vs. voluntarily treated are compared. Three studies analysed data using multivariate regression models in order to predict programme retention, absconding, substance use outcome, participation in self help groups post discharge and long term mortality. Long term mortality is also analysed using survival models (Kaplan-Meier) and standardised mortality ratios.
The Swedish National Board on Health and Welfare recommends that structured assessment instruments should be used in medical as well as in social treatment of substance misusers. These should be validated in a Swedish context. Instruments for diagnoses of dependence/abuse (DSM-IV) and dependence/harmful use (ICD-10) have been used in Sweden for many years, although not yet validated in Swedish. ADDIS, Swedish version of the American SUDDS, is used in four Nordic countries and the most often used diagnostic instrument in Sweden. This article investigates the psychometric properties of ADDIS alcohol module, including discriminant and construct validity and internal consistency. The two main constructs in DSM – dependence and abuse – as well as the seven criteria for dependence and the four criteria for abuse are studied. Further, the value of each of the 44 specific items in ADDIS for capturing these criteria is studied.
Two samples are explored: 1) a clinical sample (n = 349; incl. 129 women) and 2) a sample of 400 men convicted for driving while intoxicated. Mean age was the same (41 ys.). Using discriminant analyses on lifetime prevalence, the items correctly classify 94 % of the cases in the two samples. Using one-factor principal component analysis to explore homogeneity of the combined samples, all 28 items on dependence and 15 of 18 items on abuse have loadings above 0,40 (R2 dependence = 0,46; abuse = 0,40). Separate analyses of the two samples, as well as on women, show similar results. Cronbach’s alpha is excellent for dependence and satisfactory for abuse in all analyses. Analyses of specific criteria show satisfactory results on dependence and acceptable on abuse. Minor revisions are proposed to make ADDIS more user-friendly and to improve some specific items. In conclusion: ADDIS has acceptable to excellent discriminant and construct validity as well as internal consistency and captures the specific criteria of DSM-IV. It has the preconditions for sensitive assessment of alcohol use disorders in men and women.
Hur fungerar eftervården efter LVM? I vilken omfattning finns den och vad har den för innehåll? Behövs den? Det är några frågor som berörs i denna artikel av Arne Gerdner, lektor i socialt arbete, Mitthögskolan, Östersund, som tidigare har presenterat många studier om LVM-vården och dess utfall. Ibland diskuteras under begreppet "eftervård" även andra viktiga stödåtgärder som handlar om boende, sysselsättning och försörjning etc. Andra har påvisat stora brister i dessa avseenden (se t.ex. Yohannes m.fl. 2002). Denna artikel koncentreras dock på frågan om eftervård i en snävare mening, dvs insatser som handlar om stöd, vård och behandling med fokus på att hantera missbruket.
Laws concerning compulsory care for alcoholics and drug addicts exist in the great majority of countries, although with great variations in lengths, legal systems, and ambitions. In many countries, compulsory care is the last resort when society doesn't accept to let go of the most severe cases. They suffer often from somatic and mental comorbidity and poor quality of life. At the same time they are also least motivated to accept voluntary help. Professional helpers may feel hopeless about them. There is now a growing body of research concerning evidence-based models for psychosocial rehabilitation of alcoholics and drug addicts. But, what about compulsory care? What do we know from Swedish and international experiences? This presentation concern (1) the international use of compulsory commitment, (2) factors in severe cases that affect motivation to treatment, (3) evidence-based models for psychosocial rehabilitation, and (4) synthesis of research on some factors in compulsory care.
Childhood maltreatment is delicate to assess both in clinical work and in research. There is a need for assessment tools that can be easily administered in an ethical and non-intrusive way that meets requirements of conceptual validity for various types of maltreatment and is sensitive to levels of severity. This study explores the psychometric properties of the Swedish translation of one such toolthe Childhood Trauma QuestionnaireShort Form (CTQ-SF; Bernstein and Fink, 1998). The CTQ-SF was administered to seven samples (total n=659)five clinical samples and two non-clinical student samples. The factor structure supports the construct validity of the global maltreatment scale, four of the five maltreatment subscales (emotional abuse, physical abuse, sexual abuse and emotional neglect) and the minimization/denial (MD) scale, but not the physical neglect (PN) subscale. All items are highly correlated with their respective subscale. The discriminant validity is satisfactory. Highly significant correlation with social desirability gives further support for the MD-scale and to the recommendation of how to apply it. Internal consistency of PN is acceptable and for all other scales satisfactory. Swedish norm groups tend to score lower than similar American norm groups on abuse scales but higher on the neglect scales. Percentiles for seven gender-specific norm groups are presented. The weaknesses of the PN-scale are discussed and new constructs are proposed. The Swedish version of the CTQ-SF has the same construct validity and internal consistency as the original, including less homogeneity of the PN scale.
This study concerns the relation between mortality and the short-term outcome of inpatient treatment for alcoholism. A total of 121 patients (87 men, 34 women) of whom 89 were voluntary and 32 compulsorily committed. They had a mean age of 41 ±7 (sd) years and attended a 5-week programme at Runnagården, Örebro, Sweden. Most patients were socially unstable and severely alcohol dependent. Ten months (mean) after discharge, 96% of the patients and their referring social workers were contacted with mail questionnaires. Of these patients, 13% had been totally abstinent and a further 42% were improved but had had relapses. After a mean of 8.5 ±0.27 (sd) years, 27 patients (24%) had died. All abstainers survived, but non-abstainers had a 9 times higher mortality than expected. Non-abstinent improved women tended to survive longer than non-improved women, but among non-abstinent improved men no such tendency was found. In conclusion, a reduction in the frequency and quantity of abusive drinking was not enough to reduce the higher risk of death. Only abstinence seemed to be preventive.
Tvångslagstiftning som möjliggör vård av vuxna personer med tungt missbruk är vanligt internationellt. I en studie av 24 europeiska länder hade 21 en sådan lagstiftning år 1999 och 19 år 2009. En begränsad litteratur finns internationellt och nationellt vad gäller randomiserat kontrollerade studier och kvasiexperimentella studier om effekt av socialt tvång. Dessutom finns ett antal förloppsstudier. Baserat på dessa studier är det möjligt att dra följande slutsatser.
Tvångsvård där samtycke om frivillig vård ej finns ökar förutsättningarna för att vård skall komma till stånd och förbättrar fullföljandet av vården. Tvångsföreskrift kan också öka fullföljande av eftervård. Utfall av vård och eftervård som ges med tvångsföreskrift är lika bra eller bättre än utfall av motsvarande frivillig vård för motsvarande patientgrupper. Personernas problemnivå samt vårdens och eftervårdens innehåll och omfattning är avgörande för resultaten i tvångsvård, precis som i frivillig vård.
Strukturerade behandlingsmetoder som i frivillig vård visat sig ge vara effektiva, kan användas även inom tvångsvården. Initiativ till utbildningar har tagits under senare år och det är viktigt att studera implementeringen av dem. Vårdens kvalitet är också av stor betydelse för att minska de negativa upplevelserna av tvånget som förekommer hos de flesta intagna. Denna upplevelse kan vara starkare och mer långvarig än hos dem som vårdas enligt psykiatrisk tvångslag.
Flera stora projekt har de senaste åren inriktats på en förbättrad integrering av initial institutionsvård och strukturerad eftervård. Resultaten är lovande men ännu ej konklusiva. Studierna visar positiva behandlingsresultat. ESS-projektet är en randomiserad studie vilket ökar möjligheterna till slutsatser. Vårdkedjeprojektet och Ett kontrakt för livet är andra omfattande men ej randomiserade projekt med betoning på eftervården