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S Vallgårda

Publications and source records attributed to S Vallgårda.

13 recordsLinked to original sources

Governing people's lives. Strategies for improving the health of the nations in England, Denmark, Norway and Sweden.

Public health strategies reflect governments' wish to make people's lives longer and healthier. This can either be achieved by influencing the frames of people's lives and activities or the way they behave, i.e. to try to 'conduct their conduct'. In this paper the motivations for and methods of four national public health strategies are analysed. They are the English, the Norwegian, the Danish and the Swedish. Four questions are addressed: i) how is the governing activities aimed at improving the health of the population justified; ii) which issues are defined as problems; iii) which causes of the problems are identified; and iv) which governing techniques are suggested to solve the problems. The English and Danish programmes focus on mortality while the others give high priority to non-lethal diseases and conditions. The Danish programme mainly aims at making people conduct themselves in a more healthy way, i.e. change their behaviour, often guided by health professionals. The Norwegian paper has empowerment as its central strategy. The strategy is based on the assumption that if people get more power over their own lives they will become more healthy and behave in a more healthy way. The Swedish emphasis is on changing people's living conditions and much less is said about the role of the individual. The English programme launches a national contract where individuals and authorities should work both to change people's behaviour and their living conditions. All strategies deal with the increasing social inequality in health, the English and Swedish strategies more than the others. There does not seem to be a specific Nordic model in this field of welfare state politics.

England↗

Is old age necessarily connected with high hospital admission rates?

The proportion of old people in a population is often taken as an indicator of the perceived need for and utilization of health services. What is the relation between age and hospital admission rates, and has it changed over time? These questions are investigated by a study of hospital statistics. In 1930 hospitalization rates were approximately the same for all age groups. In 1950 there was an increase with increasing age for men, but not for women, who had experienced a general increase in all age groups. In 1979 there was a pronounced increase in hospitalization rates in the high age groups for both sexes; this increase has been even more marked in the decades since. The number of admissions per 1,000 inhabitants over 64 years of age increased from 296 in 1979 to 418 in 1993. Changes in diagnoses and operation patterns for old patients during the last decade illustrate marginal changes in disease patterns and a slight increase in some types of surgery. An increase in readmission rates contributes substantially to the overall increase. The proportion of old people in a population tells us very little about perceived need for health services and cannot be used to predict hospital admission rates.

Aged↗

The rise, heyday, and incipient decline of specialization: hospitals in Denmark, 1930-1990.

Between 1930 and 1990 Denmark's hospital sector and hospital policy underwent radical changes. In 1930 the sector was dominated by many small hospitals, with care as the central task. By 1990 the number of hospitals had almost halved, specialization had developed, and diagnostic and therapeutic procedures were hospitals' most important functions. There have been many claims that the shape of the health care sector is determined by the development of medicine. This article demonstrates that changes in other areas of society have greatly influenced the development of the Danish hospital sector. In the 1930s and 1940s, the focus was on equity and specialization; in the 1950s, on growth, rationalization, and division of labor; in the 1960s, on growth and planning; and during the last decades, on management, productivity, and cost containment. Since 1980 the specialization, growth, and political acceptability of the specialized hospital sector have decreased, a change that can be characterized as the incipient decline of the specialized hospital sector.

Adolescent↗

Why was the perinatal mortality rate higher in Denmark than in Sweden? The development in the 1970s and 1980s.

The purpose of this article is to identify factors explaining why the perinatal mortality rate ceased to fall in Denmark during the 1980s, while it continued to do so in Sweden, and to study the ability of known risk factors to predict this development. My analysis is based on routinely collected published data on all births, where I have studied the levels and changes in known risk factors for perinatal deaths in the two countries. The results of the study are: The proportion of low birth weight infants and the mothers' age and parity did not differ or change in a way that explains the higher perinatal mortality rate in Denmark during the 1980s. The weight specific perinatal mortality rate was the same in the two countries, with the exception of very low birth weight babies, i.e. below 1,500 grammes, where the perinatal mortality rate was higher in Denmark; this difference increased during the 1980s. The proportion of very low birth weight infants increased in Denmark from the 1970s to the 1980s while it remained stable in Sweden. The Danish increase in the proportion of low birth weight infants can be due to changed registration practices with more very small infants being registered in the 1980s. Among the factors studied registration practices, smoking and neonatal care seemed to be able to explain part of the differences between the two countries. The relative risk of perinatal death associated with the mothers' age and parity varied depending on the size of the groups at risk: the more women in high age and parity groups the lower the relative risk, which indicates that a selection as well as a causal effect was present. A conclusion is that the changes in relative risk over time associated with age and parity should lead to a closer investigation of the characteristics actually associated with an increased risk in order not to treat all old and multiparous women as patients at risk.

Birth Order↗

Review essay: the history of medicine in Denmark.

Medical history in Denmark has during the last decade received increasing interest from historians and other researchers outside medicine. Three main areas have been investigated: history of medical science and ideas, history of health services, and historical epidemiology. The area is in rapid growth and characterized by a high degree of interdisciplinarity.

Denmark↗

Trends in perinatal death rates in Denmark and Sweden, 1915-1990.

Perinatal mortality rate (PMR) is often taken as an indicator of the quality of obstetric care. Its decline started in the early 1940s in Denmark and Sweden, at the same time as in several other European countries, and its development has been strikingly parallel in the two Scandinavian countries. The changes in the mothers' ages and birth order do not coincide with the changes in the PMR. The percentage of children born weighing less than 2500 g has been very stable over time, albeit higher in Denmark. The move towards hospital confinements in obstetric care took place mainly in the 1930s in Sweden, i.e. before the decline started, and in the 1950s and 1960s in Denmark. The factors investigated have contributed very little to explain why the PMR started to decline in the early 1940s. Factors associated with the distribution of perinatal deaths in a population do not seem to be able to explain the changes taking place over time. In the current study it is postulated that factors behind the change in the PMR are improvements in the mothers' health together with the decline in the total period fertility rate from the beginning of this century. With a smaller number of children the risk of infection was reduced and the amount of food available to each child and pregnant woman increased. This better health in early life may be associated with improved reproductive health in the adult years.

Birth Order↗

Increased obstetric activity: a new meaning to "induced labour"?

This study examines the possible reasons for increased obstetric activity in Denmark over the past 25 years. Since 1960 there has been a substantial increase in the average number of hospital admissions (from 10 to 32 per 100 deliveries), in deliveries diagnosed as complicated (from 15 to 49%), and above all in major interventions at delivery (from 4 to 22%). In spite of this increase in activity there is no evidence that the postwar trend of decreasing perinatal mortality has been further improved during the period of study. It seems possible that the rising level of activity is the result of increasing availability of new technology, decreasing numbers of deliveries and unchanged obstetric staffing levels, with an increased tendency to diagnose and intervene in "at risk" pregnancies. There is a need to determine how the current level of obstetric activity has arisen. Since there is evidence for an increased expectation of intervention by pregnant women, the theory of supplier induced demand may be among the leading contenders to be tested.

Adult↗

Mammography.

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Breast Neoplasms↗