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Search Results: 1 - 10 of 11273 matches for " Stefan Peterson "
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Views on sick-listing practice among Swedish General Practitioners – a phenomenographic study
Malin Swartling, Stefan Peterson, Rolf Wahlstr?m
BMC Family Practice , 2007, DOI: 10.1186/1471-2296-8-44
Abstract: Semi-structured interviews with 19 GPs in 17 Primary Health Care settings in four mid-Sweden counties. Interview transcripts were analysed with phenomenographic approach aiming to uncover the variation in existing views regarding the respondents' sick-listing commission and practice.We found large qualitative differences in the GPs' views on sick-listing. The sick-listing commission was experienced to come either from society or from patients, with no responsibility for societal interests, or as an integration of these two views. All the GPs were aware of a possible conflict between the interests of society and patients. While some expressed feelings of strong conflict, others seemed to have solved the conflict, at least partly, between these two loyalties.Some GPs experienced carrying the full responsibility to decide whether a patient would get monetary sick-leave benefits or not and they were not comfortable with this situation. Views on the physician's and the patient's responsibility in sick-listing and rehabilitation varied from a passive to an empowering role of the physician.GPs expressing a combination of less inclusive views of the different aspects of sick-listing experienced strong conflict and appeared to feel distressed in their sick-listing role. Some GPs described how they had changed from less to more inclusive views.The clearer understanding of the different views on sick-listing generated in this study can be used in educational efforts to improve physicians' sick-listing practices, benefiting GPs' work situation as well as their patients' well-being. The GP's role as a gatekeeper in the social security system needs further exploration. Our findings could be used to develop a questionnaire to measure the distribution of different views in a wider population of GPs.Physicians' sick-listing practice is one determinant for the level of sick-listing [1]. The number of people on sick-leave benefits in Sweden more than doubled between 1997 and 2002 with
Poor newborn care practices - a population based survey in eastern Uganda
Peter Waiswa, Stefan Peterson, Goran Tomson, George W Pariyo
BMC Pregnancy and Childbirth , 2010, DOI: 10.1186/1471-2393-10-9
Abstract: All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome.There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9).Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy.In low income countries (LICs), progress towards achieving Millennium Development Goal 4 - to reduce by two-thirds under-5 mortality from the 1990 baseline - is being hampered by slow progress in reducing neonatal death [1]. The neonatal period is only 1/60 of the first five years of life, but contributes 38% of the estimated 10.5 million under-five deaths which occur every year [2].
Utilization of public or private health care providers by febrile children after user fee removal in Uganda
Elizeus Rutebemberwa, George Pariyo, Stefan Peterson, Goran Tomson, Karin Kallander
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-45
Abstract: Structured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga – Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics.Of those who sought care outside the home, 62.7% (286/456) had first gone to drug shops/private clinics and 33.1% (151/456) first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10 – 3.89) and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84 – 18.26) or experienced (OR 1.93; 95% CI 1.07 – 3.48). Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08 – 0.52).Private providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.Infant and child mortality rates due to febrile illnesses are high in resource poor countries, especially in sub-Saharan Africa [1]. With the millennium development goal number four, many countries have targeted to reduce under-five mortality of the 1990 level by two thirds by 2015 [2]. In Uganda, there is a high disease burden from febrile illnesses with malaria contributing 30 – 50% of outpatient burden and 35% of hospital admissions [3]. Those affected by malaria are mostly women and children under five years. Much of
Socioeconomic differences in the burden of disease in Sweden
Ljung,Rickard; Peterson,Stefan; Hallqvist,Johan; Heimerson,Inger; Diderichsen,Finn;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005000200009
Abstract: objective: we sought to analyse how much of the total burden of disease in sweden, measured in disability-adjusted life years (dalys), is a result of inequalities in health between socioeconomic groups. we also sought to determine how this unequal burden is distributed across different disease groups and socioeconomic groups. methods: our analysis used data from the swedish burden of disease study. we studied all swedish men and women in three age groups (15-44, 45-64, 65-84) and five major socioeconomic groups. the 18 disease and injury groups that contributed to 65% of the total burden of disease were analysed using attributable fractions and the slope index of inequality and the relative index of inequality. findings: about 30% of the burden of disease among women and 37% of the burden among men is a differential burden resulting from socioeconomic inequalities in health. a large part of this unequally distributed burden falls on unskilled manual workers. the largest contributors to inequalities in health for women are ischaemic heart disease, depression and neurosis, and stroke. for men, the largest contributors are ischaemic heart disease, alcohol addiction and self-inflicted injuries. conclusion: this is the first study to use socioeconomic differences, measured by socioeconomic position, to assess the burden of disease using dalys. we found that in sweden one-third of the burden of the diseases we studied is unequally distributed. studies of socioeconomic inequalities in the burden of disease that take both mortality and morbidity into account can help policy-makers understand the magnitude of inequalities in health for different disease groups.
Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework
Bergstr?m Anna,Peterson Stefan,Namusoko Sarah,Waiswa Peter
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-117
Abstract: Background A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this ‘know-do’ gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the sub-elements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. Methods This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. Results The sub-elements of organizational context in the PARIHS framework—i.e., receptive context, culture, leadership, and evaluation—also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. Conclusions In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings—resources, community involvement, and commitment and informal payment—should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate sub-element of the PARIHS framework as a whole.
Observational Requirements for High-Fidelity Reverberation Mapping
Keith Horne,Bradley M. Peterson,Stefan J. Collier,Hagai Netzer
Physics , 2002,
Abstract: We present a series of simulations to demonstrate that high-fidelity velocity-delay maps of the emission-line regions in active galactic nuclei can be obtained from time-resolved spectrophotometric data sets like those that will arise from the proposed Kronos satellite. While previous reverberation-mapping experiments have established the size scale R of the broad emission-line regions from the mean time delay t = R/c between the line and continuum variations and have provided strong evidence for supermassive black holes, the detailed structure and kinematics of the broad-line region remain ambiguous and poorly constrained. Here we outline the technical improvements that will be required to successfully map broad-line regions by reverberation techniques. For typical AGN continuum light curves, characterized by power-law power spectra P(f) ~ f^{-a} with a = -1.5 +/- 0.5, our simulations show that a small UV/optical spectrometer like Kronos will clearly distinguish between currently viable alternative kinematic models. From spectra sampling at time intervals T_res and sustained for a total duration T_dur, we can reconstruct high-fidelity velocity-delay maps with velocity resolution comparable to that of the spectra, and delay resolution ~2 T_res, provided T_dur exceeds the BLR crossing time by at least a factor of three. Even very complicated kinematical models, such as a Keplerian flow with superimposed spiral wave pattern, are cleanly resolved in maps from our simulated Kronos datasets. Reverberation mapping with Kronos data is therefore likely deliver the first clear maps of the geometry and kinematics in the broad emission-line regions 1-100 microarcseconds from supermassive black holes.
A new direct method for measuring the Hubble constant from reverberating accretion discs in active galaxies
Stefan Collier,Kieth Horne,Ignaz Wanders,Bradley M. Peterson
Physics , 1998, DOI: 10.1046/j.1365-8711.1999.02250.x
Abstract: We show how wavelength-dependent time delays between continuum flux variations of AGN can be used to test the standard black hole-accretion disc paradigm, by measuring the temperature structure $T(R)$ of the gaseous material surrounding the purported black hole. Reprocessing of high energy radiation in a steady-state blackbody accretion disc with $T \propto R^{-3/4}$ incurs a wavelength-dependent light travel time delay $\tau \propto \lambda ^{4/3}$. The International AGN Watch multiwavelength monitoring campaign on NGC 7469 showed optical continuum variations lagging behind those in the UV by about 1 day at 4800\AA and about 2 days at 7500\AA. These UV/optical continuum lags imply a radial temperature structure $T \propto R^{-3/4}$, consistent with the classical accretion disc model, and hence strongly supports the existence of a disc in this system. We assume that the observed time delays are indeed due to a classical accretion-disc structure, and derive a redshift independent luminosity distance to NGC 7469. The luminosity distance allows us to estimate a Hubble constant of $H_{0} (\cos i / 0.7)^{1/2} = 42\pm9 \Hubble$. The interpretation of the observed time delays and spectral energy distribution in the context of an accretion disc structure requires further validation. At the same time, efforts to minimize the systematic uncertainties in our method to derive a more accurate measurement of $H_{0}$, e.g by obtaining an independent accurate determination of the disc inclination $i$ or statistical average of a moderate sample of active galaxies, are required. However, this remains a promising new method of determining redshift-independent distances to AGNs.
Acceptability of evidence-based neonatal care practices in rural Uganda – implications for programming
Peter Waiswa, Margaret Kemigisa, Juliet Kiguli, Sarah Naikoba, George W Pariyo, Stefan Peterson
BMC Pregnancy and Childbirth , 2008, DOI: 10.1186/1471-2393-8-21
Abstract: We conducted 10 focus group discussions consisting of mothers, fathers, grand parents and child minders (older children who take care of other children). We also did 10 key informant interviews with health workers and traditional birth attendants.Most maternal and newborn recommended practices are acceptable to both the community and to health service providers. However, health system and community barriers were prevalent and will need to be overcome for better neonatal outcomes. Pregnant women did not comprehend the importance of attending antenatal care early or more than once unless they felt ill. Women prefer to deliver in health facilities but most do not do so because they cannot afford the cost of drugs and supplies which are demanded in a situation of poverty and limited male support. Postnatal care is non-existent. For the newborn, delayed bathing and putting nothing on the umbilical cord were neither acceptable to parents nor to health providers, requiring negotiation of alternative practices.The recommended maternal-newborn practices are generally acceptable to the community and health service providers, but often are not practiced due to health systems and community barriers. Communities associate the need for antenatal care attendance with feeling ill, and postnatal care is non-existent in this region. Health promotion programs to improve newborn care must prioritize postnatal care, and take into account the local socio-cultural situation and health systems barriers including the financial burden. Male involvement and promotion of waiting shelters at selected health units should be considered in order to increase access to supervised deliveries. Scale-up of the evidence based practices for maternal-neonatal health in Sub-Saharan Africa should follow rapid appraisal and adaptation of intervention packages to address the local health system and socio-cultural situation.The Millennium Development Goal (MDG) 4 – to reduce under-five mortality by two thirds,
Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys
Henry Wamani, Anne ?str?m, Stefan Peterson, James K Tumwine, Thorkild Tyllesk?r
BMC Pediatrics , 2007, DOI: 10.1186/1471-2431-7-17
Abstract: Data from the most recent 16 demographic and health surveys (DHS) in 10 sub-Saharan countries were analysed. Two separate variables for household socio-economic status (SES) were created for each country based on asset ownership and mothers' education. Quintiles of SES were constructed using principal component analysis. Sex differentials with stunting were assessed using Student's t-test, chi square test and binary logistic regressions.The prevalence and the mean z-scores of stunting were consistently lower amongst females than amongst males in all studies, with differences statistically significant in 11 and 12, respectively, out of the 16 studies. The pooled estimates for mean z-scores were -1.59 for boys and -1.46 for girls with the difference statistically significant (p < 0.001). The stunting prevalence was also higher in boys (40%) than in girls (36%) in pooled data analysis; crude odds ratio 1.16 (95% CI 1.12–1.20); child age and individual survey adjusted odds ratio 1.18 (95% CI 1.14–1.22). Male children in households of the poorest 40% were more likely to be stunted compared to females in the same group, but the pattern was not consistent in all studies, and evaluation of the SES/sex interaction term in relation to stunting was not significant for the surveys.In sub-Saharan Africa, male children under five years of age are more likely to become stunted than females, which might suggest that boys are more vulnerable to health inequalities than their female counterparts in the same age groups. In several of the surveys, sex differences in stunting were more pronounced in the lowest SES groups.Linear growth retardation or low height-for-age, commonly known as stunting is a useful anthropometric measure for children in terms of its positive correlation with social and economic deprivation. Stunting is now acknowledged as the best proxy measure for child health inequalities [1,2]. This is because stunting captures the multiple dimensions of children's health, d
Community referral in home management of malaria in western Uganda: A case series study
Karin K?llander, G?ran Tomson, Jesca Nsungwa-Sabiiti, Yahaya Senyonjo, George Pariyo, Stefan Peterson
BMC International Health and Human Rights , 2006, DOI: 10.1186/1472-698x-6-2
Abstract: A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs) were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral.Overall referral rate was 8% (117/1454). Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93%) "urgent referrals" accessed referral care but 8 (31%) delayed >24 hours. Waiting for antimalarial drugs to finish caused most delays. Of 32 possible pneumonias only 16 (50%) were urgently referred; most delayed ≥ 2 days before accessing referral care.The HBM has high referral compliance and extends primary health care to the communities by maintaining linkages with formal health services. Referral non-completion was not a major issue but failure to recognise pneumonia symptoms and delays in referral care access for respiratory illnesses may pose hazards for children with acute respiratory infections. Extending HBM to also include pneumonia may increase prompt and effective care of the sick child in sub-Saharan Africa.More than 4.4 million children die every year in Sub-Saharan Africa where malaria and pneumonia are leading causes of death [1]. The decline in mortality rates here is slower than in other continents and the deceleration is worse among the poor [2]. Most children die at home without prior contact with the formal health sector [3]. Constrained health systems and non-functional referral strategies are major obstacles for effective primary health care delivery; both essential to curb the under-five mortality and achieving Millennium Development Goals [4].To increase prompt presumptive treatment of malaria Uganda introduced Home Based Management of fever (HBM) [5]. Two volunteer drug distributors (DDs) per village are trained for three days
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