The Swedish Elderly and Psychiatric Healthcare as Models: An Investigation into the Social Importance of Healthcare and Biomedical Science Research

Sweden continues to enjoy the elderly and psychiatric healthcare in its welfare state. This development could not have been successful without the hard work of biomedical scientists and their researchers. We investigate in this study the involvement of biomedical research, its personnel and the way it has championed new knowledge and confidence in the industries as a whole. Moreover, the psychiatric work in prison institutions is investigated to find out how inmates are being helped by these professionals to deal with their guilt.


Introduction
The Elderly healthcare system and the Psychiatric healthcare in Sweden have one of the most advanced models that any developed or developing nation could emulate. At a glance, the novice may not discover the strategic development behind this care which caters to the seniors in society. The meticulous thinker would observe that this care of the seniors and the psychiatric care of prisoners are not only important industries by themselves but also are stupendous backbones of the welfare state. Sweden nation has been a welfare state for more than five decades ago. This development could not have been successful without the contribution of biomedical science and research. We will investigate in this study the involvement of biomedical research, its personnel, and the way it has championed new knowledge and confidence in the industries as a whole.

The Objective of the Study
The purpose of the article is to study the conditions which make the care of the elderly industry grow and also suggest its emulation by the developing nations. We shall also find how the development of biomedical science, its personnel and research has generated the continued progress in healthcare. The study will contribute to the analysis of data that shows there is progress in the Prison Institution's welfare program. These empirical materials will reveal rigorous analysis through thorough investigations.

Main Hypotheses
The Carers' work will have a positive effect on the inmate's attitudes and behaviors.
The inmates' deeply felt positive mood and their church attendance practices will have a positive effect on the inmates' attitudes and behaviors.

Background Data and the Importance of the Study
Elderly care consists of one of the universal and comprehensive social and health care programs in Sweden. The taxes of the citizens fund the care system. Sweden allocates 3.6% of its GDP on longterm care and gives the highest healthcare employees for the elderly over 65 years. In 2013, Sweden became the first among the countries that provide superb care to its elderly. The United Nations-supported global study and The Global Age Watch Index (BBC) made this information available. The nation constantly institutionalizes reforms that are high-quality long-term care for the elderly institutions and home care. The municipalities take responsibility for elderly care and issue funds for home assistance.
It also controls the prerequisite of available housing. Currently, 94% of the elderly over 65 years are living in their homes. These seniors live independent lives and still receive their home assistance. If an elderly require assistance from a healthcare worker, she could apply and get it. There are cooked meals which the elderly could request for them, and she will get them. One behavioral characteristic which concerns every Swede is independence. Caretaking of the elderly adapts to this common characteristic. The caretaking of the elderly in their homes allows them to enjoy this independence. It consoles family members to have their peace of mind knowing that their loved ones will receive superb care and love from professionals. In addition to this, the seniors could choose to stay at home or join a nearby care company where several elderly persons live. The care where the elderly receives their choices comes from the fact that the elderly has contributed to the various communities where they once lived. They have worked day and night, raised their families, and paid their taxes, according to the laws of the nation. As written by Martina Lesperance, "they deserve to receive the same high quality of care. In addition to the care the elderly receive, health care workers are needed and appreciated. So, it is a win-win situation for everybody: the elderly, their families, as well as all current and futures citizens of Sweden [1].

Healthcare and Biomedical Science Contribution
The Swedish elderly care as an institution continues to receive modernization and development. But the major contribution comes from biomedical science, its personnel, and research, which championed new knowledge that the different commissions that the state instituted utilized to make changes. Science research has helped the care industry to be modernized to incorporate several health models. This enhanced the single purpose of allowing people to enjoy their independence without infringing on the quality aim enshrined in the core objectives. The CSW continually discusses its area of responsibility and takes up and analyses the previous meetings.

Detentions:
The task of the members of the CSW is to organize a private conversation with inmates. Where certain restrictions are placed on inmates, pastors, with the help of some staff are allowed to visit inmates in their cells. Inmates decide whether or not they will be willing to have a priest come in and converse with them.
Those in detention are by law not guilty but for security reasons must be in detention until the day of their trial. Most inmates, therefore, find it difficult because the longer the period they stay, the more they may develop existential crisis and fear. Not only them, but also members of the family become worried. The lesser outside contacts mean that they cherish every bit of personal conversation with the pastor. It is the time to adapt to change concerning their whole life situation. Moreover, isolation causes an inmate to take some decisions whose consequences could not be determined. Christian tradition indeed presents cases of incest, adultery, and, even amid patriarchal domination, marital conflict. Though these stories illustrate that the human concern with family matters is not a problem in modern times, the kind of guidance they offer to families living today is controversial. Here, advice is given to the care practitioner that he/she must search for the central features of the Christian message about the family and focus on the center as against the peripheral elements that are also in view [6]. Berger states in his work that the intimacy and closeness involved in special relationships are best facilitated by the construction of a common world through conversation [7]. The work of Lyman and Adele Wynne which sought to explain clearly the word "intimacy" comprehend it as a subjective relational experience in which the core components are trusting self-disclosure and communicated empathy [8]. Malone and Malone see both closeness and intimacy as vital and, therefore, inseparable. According to them, a balancing of closeness is necessary for any relationship that is special. Without closeness, they assert, intimacy would be chaotic. Without intimacy, closeness would and does insidiously deteriorate into role-playing and boredom [9]. Whereas the prototype of closeness is a personal experience, in the sexual experience both persons are much more aware of themselves than they are of the other [10]. for oneself and care for others to whom one is specially related [11].

Swedish Healthcare Focuses on Therapy
The Healthcare system developed by the Swedish is not focused on relationships alone but also focused on therapy, which is, treating and nurturing the person. This is the reason why I find it necessary to discuss psychotherapy. Psychotherapy is more readily employed where the objective of "constructive change" makes more deliberate and consistent use of psychological mechanisms and processes. In psychotherapy, the "caring relationship" is put on a more professional basis (implying education, expertise, dedication, responsibility, and membership of a relevant institution on the part of the therapist) " [12]. Here, biomedical scientists dominate in bringing treatment to many people involved in healthcare. Stein's work entitled Guilt: Theory and Therapy explores the necessity for understanding our guilt and its application in psychiatry, psychology, sociology, and religion. He studies in depth the ordinary individual, the sociopath who does not suffer from guilt, and the neurotic who feels over-guilty. In where he discusses "Guilt in the Sociopathic personality" [13] he says the American Psychiatric Association defines "psychopath" as a person whose behavior is predominantly amoral or anti-social and characterized by impulsive, irresponsible actions satisfying only immediate and narcissistic interests, without concern for obvious and implicit social consequences, accompanied with minimal outward evidence of anxiety or guilt [14]. Sociopathic personality is a precise term McCords, on the other hand, without depreciating the value of the precision in the diagnosis of its obvious clinical value, focuses on aggressiveness, guiltiness, affectional shallowness, and extreme impulsivity" as a central core of the psychopath's syndrome [15].
They emphasize guiltlessness and lovelessness as the two traits which "conspicuously mark the psychopath as different from other men [16]. Cleckley attributes the following characteristics to the primary psychopathic personality:  c) The unconscious, irrational threat implied in shame anxiety is abandonment and not mutilation (castration) as in guilt. d) The law of Talion does not obtain in the development of shame, as it generally does in guilt [18].

Summary of the Review
The behavioral feature which is conjoint with every Swedish home is independence. Healthcare taking of the elderly, as well as the prisoner, adapt to this common characteristic. When caretaking occurs to the elderly in their homes and the prisoner in his cell, it allows them to enjoy corporate independence. It consoles family members to have their peace of mind knowing that their loved ones will receive superb care and love, even in the prisons with professionals, such as biomedical doctors, nurses, physiotherapists, dentists, dieticians, psychologists, etc. In addition to this, the seniors choose to stay at home or join a nearby care company where several elderly persons live. Biomedical doctors and nurses all play their part in the healthcare industry. They prescribe the drugs and provide healthcare with outstanding involvement. The care where the elderly, as well as the prisoner, receive their choices can be attributed to the fact that the elderly and for that matter, all persons, have contributed to their various communities where they once lived. They have worked day and night, raised their families, and paid their taxes, according to the laws of the nation.
The citizens deserve to receive the same high quality of healthcare.
In addition to the care the elderly receive, healthcare workers are needed and appreciated. They receive good income and training to make them feel good and professionally oriented. So it is a win-win situation for everybody. The elderly, the prisoner and their families, as well as all current and futures citizens of Sweden, wins.

Methodology in the Empirical Studies in Health Care
The empirical studies I conducted in the health care industries did not take place on one occasion. Between 1995 and1998, I can only present data in the first-mentioned health care publicly and for the rest of the data, I will employ my own anonymous work experiences without using specific data from them. This is because I have to observe the code of ethics, which is known as tystsnadplikt.
The interview method has some problems though it is a more systematic way of gathering data. Through a better-structured technique, one can have more objective data, which can eventually be helpful for the investigation and control of mistakes. Despite this advantage, according to Hyman et al. [19][20][21], the interview method has some problems, which often result when they are not  [19]. Furthermore, the role between the interviewer and the respondent can be changed in different ways as situational disturbances arise. Such as the interviews' variation as it concerns the penal systems of individual questions and interview variations as it concerns the jotting down of notes can create unreliability. According to Hyman et al. [19][20][21], one can avoid some of these mistakes if a researcher uses the services of a trained interviewer in gathering his data [20]. In this study, I also utilized the questionnaire method because it has an advantage over the other methods. In that, it reduces the importance of the interviewer. The interviewers' personality as able to influence the answers respondents to give does not come. Complications, which often arise during the communication process, disappear. The questionnaire technique is the most structured and standardized method, and that was one of the main reasons I resolved to utilize this in my data collection [21]. questions, tests, files, and institutional analyses, portray reality to an even lesser degree than would be expected through observation [22]. The choice of observation could indeed have helped me to view certain partial aspects of such a complex field, yet I could not embark upon it as I had wanted due to certain restrictions. Though it portrays a better reality, the observation method is the less structured and less standardized approach to collecting data. Again, if we understand that there are many restrictions placed on prison research, then we could say that the response rate was, on a whole, satisfactory.

Statistical analyses and the Validity and reliability of the Data
The question of validity draws attention to how far a measure measures the concept, which it purports to measure. The reliability of a measure refers to its consistency. In the prison research, inmates suspect researchers who approach them as agents of the police force. Such suspicion leads some inmates to give false and misleading answers to questions presented to them by researchers.
In this research, however, I made it clear to the inmates who I was, repeating to them that I was a private researcher who intends to interview them about the work of the chaplains and how it affects

A Day in the Elderly Care at Karl Johangårdet in Uppsala
The care of the elderly receives superb organization and accountability, which the CEO champions herself. Her profession is a nurse. Each elderly has her/his apartment except those couples who have agreed that they would stay in the same room.

Remarks on Biomedical Science, Personnel and Research
We mentioned at the outset that the development of healthcare in the Elderly care and Psychiatric ward could not have been successful without the contribution of biomedical science, its personnel, and

Welfare Organizers and their functions in the Prison Institutions
The Let us present these roles and their percentages of importance.
37% of the chaplains chose the variable "Example," that is, the role of the chaplain as being in the prison to set a good example to the inmates as "Very important" in the work among inmates.
About 21% chose "Quite important." Only 26% were "undecided," "Not very important," 5%, and "Absolute not important" 11%. There was not much difference as regards the chaplain's work concerning his being ready and available to the inmates and the staff. "Availability" was regarded as an important role by 35% of the chaplains and 7% viewed it as "Absolutely not important." Among the roles, "Teaching," "Administration" and "Preaching" received very low percentages in the "Very important" category. The percentages were 3%, 6%, and 6% respectively. The "Counselling" role received a higher percentage; 87% of these chaplains reported that counseling inmates in the prison are a "very important" work.
If we add the "Quite important" function to the former it means that 92% of those who answered the questionnaires indicated that the counseling work is "important" as against "not important" and "undecided" which had a total of 8%. The rest are "Availability" 74%, "Example" 58%, "Advice" 51%, "Others" 33%, "Teaching" 32, "Preaching" 20%, and "Administration" 20%. The results of this investigation show that the majority of chaplains are aware of their being in the prison to provide healthcare and counseling to the inmates. According to this work, this is their notable task, and indeed it is demonstrated very often in their work. It is no wonder that they spend a great deal of their time to care and counsel and also give professional support to inmates who find themselves in crisis. They also provide available support to the inmates when they are receiving treatments from other biomedical professionals in the prison institutions. The results of the investigation showed that though the proportion of men (86%) to women (14%) was 6 times higher than the women (6:1), women, as well as men, found the "Counselling," "Example" and "Availability" as the most important roles in the work among the prisoners.

Organizations Attitudes and the Roles
It is also worthwhile to examine the two different organizations and their attitudes towards the four most important roles and healthcare in the prisons. We have already pointed out that the Church of Sweden's chaplains makes up 50% of all the chaplains who participated in the investigation. The remaining 50% are from the Free Churches, which comprise The Swedish Mission, The Pentecostals, The Salvation Army, The Orthodox Churches, etc.
By variance analysis, a comparison was made between the mean scores of "counselling," "example," "advice," and "availability" by the four church organizations' chaplains. The results are presented in (Table 1). For example, the one on counselling shows that the degree of freedom "between groups" is 3, and that of "within groups" is 30 which makes a total of 33. The mean square between groups is 1.0354 and within groups 0.6925. By dividing the former by the latter, we get the F Ratio 1.4951 and a probability level p = 0.2359 which is non-significant (p>0.05). Therefore, there are no significant differences in the mean scores of counselling between the four church organizations. The probability levels of the variable Example (p = 0.0874), Advise (p = 0.8106), and Availability variable (0.5485) is non-significant at p>0.05, meaning that there are no significant differences between the means scores of these variables.

The Healthcare workers on the Social Situation in Prison
The professional code of ethics cautions the caregivers to be silent concerning what transpired between them and the inmates during their counselling support. This professional secrecy has already been discussed in the work. This code also bars them from making use of materials ascertained during a counselling session. While making use of their experiences with inmates is prohibited, these carers cannot forget the effect of some of these bad experiences that happen to the inmates. The worries over these bad experiences cannot be shown publicly. On the contrary, they feel deep inside as they go about their work. Results show that they perceive the effect of some of these experiences on their minds in their day-to-day life. It is a way of asking for and seeing how the carers as human beings perceive and share the sorrow of these inmates they often come into contact with. There were some worries concerning the way some inmates are arrested, sentenced, and put in prison. Together 6% of the chaplains indicated their "great worry" and 33% "quite worry" which is a total of 39% over these problems which certain inmates face before their sentence.
However, 61% which includes those who "neither feel worried nor concerned", "Not much worry" and "No worry at all" objected to the fact that this is something that has effects on their minds.
On the other hand, concerning the case of illness or sickness of inmates, 53% of these chaplains find it a "worry" on their minds.
This shows that the chaplains are more concerned about inmates' health and well-being than how the process of the law has been executed to the cases of these inmates. When we turn to the

Am J Biomed Sci & Res
"emotional problems of immature inmates" a higher percentage of the chaplains 67% agreed that this worried them while 25% were "undecided" and 8% disagreed that it is a problem to be worried about. This is understandable, as the chaplains are there purposely to help inmates who have problems of emotional nature. It is an interesting result which, however, authenticates why they are there in the prison to help cure and support the sick souls. There are other problems that the results showed that they were concerned about and are worried over them. Some carers become worried, over the case of "Physically handicapped" 43%, "Alcoholics" 48%, "Drug addicts" 59%, "Issues about parole" 59%, "Inconsistency in judgment or sentencing" 52%, and "Preparation for release" 36%.
Also, "How the length of an individual sentence should be" 60% and "The cases of those to be deported away from their families," 86%.
The worries over the cases of drugs, about parole, inconsistency in the procedure of sentence, the length of sentences for inmates, and the deportation case are worth noting.
As statistics show, immigrant inmates go to prison due to drug trafficking or drug problems. The chaplains render altogether 80% of their services among these immigrant inmates; therefore, the chaplain acknowledging here that drug comprises one of the greatest worries is significant. Moreover, when one realizes that drug cases are among the cases that obtain maximum sentences.
As the decision of an individual being granted parole depends on the factor of good behaviour, the involvement of the chaplain is paramount. This is understandable if the issues involving parole are also a great worry to the chaplain. Ethical conduct lies in the domain of the chaplain, and this and other matters will constantly come before him. This investigation shows that problems entailing inconsistency in sentencing worry the chaplain. About 52% of these chaplains accepted that they comprise one of their worries and this is indeed the case. Among immigrants, a higher percentage of them believe that they are innocent and that the authorities have judged them wrongly. In prison, these unfortunate inmates constantly contact the chaplains and request their help. Some want the chaplain to write direct or assist them in writing to the authorities so that their cases will be looked into.
It seems many of these chaplains by their contacts with these inmates become engrossed in these problems as they are confronted with the truth about certain matters relating to the cases. The length of time for imprisonment was accepted by 60% of the chaplains that it was a problem that worries them. This is understandable because immigrant inmates often receive higher or maximum sentences because of drug involvement. The chaplain who is closest to them these inmates will contact him to do something about it for them. The chaplains face inmate's deportation as the greatest of all their worries. "Worry" could mean how often the inmates approach the chaplains for help concerning a particular problem. It could also mean that the chaplains involve themselves in the cases and become worried and, while helping others, become emotionally involved. Together 86% of the chaplains see this problem as a worry to them, and they show emotion with several cases that concern inmate's deportation. This result is particularly relevant as the investigation, which utilized in-depth interviews, uncovered a strong reaction by the chaplains. A focusing interview with one energetic chaplain revealed that they sent a couple of letters to the appropriate authorities objecting to the deportation of inmates to their various countries even when they know that these countries are stable. The scores of the chaplains' attitudes towards the social problems of inmates were analysed further with factor analysis. Inter-correlation among the items reveals that all except one of the variables correlate with each other. Correlation analysis confirms the fact that there is an internal connection among the variables of social situations. These relationships motivate us to investigate further with factor analysis. Factor analysis is primarily concerned with describing the variation or variance, which shares by the scores of people on three or more variables. It shows us how the variables or items are connected. The results of the statements show that there is a systematic pattern of the answers to the material. In one way it can be described that there is an underlying factor, which is behind the answers to the questions. That is, all the chaplains portray in their responses that they are human beings and, as a result, care for the inmate's problems. It seems they all agree to and respect one important value of their profession; the care for individuals who are in deep trouble, and this is the reason they get worried over these problems.

Social Situations, Coping Strategies and Cultural Problems in Prisons
During interviews with the chaplains, it was revealed that some of the inmates usually get disturbed over how cases involving crimes committed are settled. One pastor expressed this to me: The inmates often come to me and complain about how the Swedish Criminal Justice System is not fair to them. In one case, for example, the inmate complained to me how he would have wished to get access to some law books from the library so that he could go and find out whether a person could be tried twice on a single case.
It is a lack of understanding of the Criminal Justice System that presents a problem to the inmates. But we do our best to counsel them to have patience. Cases involving the deportation of inmates to their various countries often come to the attention of chaplains.
Here a chaplain says this: The inmates consult me before they go to the authorities to listen to whether they will deport or not. This is always a sad situation. The case of one inmate who came to me before the deportation can be narrated.
We prayed that God should be with him as he goes through this difficult situation. I also advised him that God knows that nothing will happen which is why probably he has allowed the authorities to come to such a decision. But still, the inmate was afraid. Some chaplains protested the deportation cases. In the interviews, we find these: Sending them back to their countries does not solve the problems. I think the authorities should reconsider this law and make some changes. Inmates with families and have responsibilities should be made to go under training. They should teach them about the Swedish culture and other necessary social life. Some inmates have received bad news from friends who they sent home. Some were beaten and received severe injuries, others died due to bad treatments they received when they got to their destinations. These extracts are just a few of the many responses I received from the chaplains concerning the inmate's social situations in prisons. There are other cultural difficulties that the interviews of the chaplains make us more aware of. There are cultural misunderstandings that the inmates contact the chaplains for their clarity and support. One carer has this to say: Some inmates feel embittered when they go to prison because of a mere quarrel with their wives. In many other cultures, the wife is the property of the husband. These inmates feel that they have the right to beat their wives when they misbehave.
They do not see why the authorities should arrest them. This belief is at variance with Swedish law, which states that every person must respect his/her neighbour. No one is another person's slave.

There is Another Problem that Concerns the Food They Eat in the Prisons
The majority of immigrant inmates find it a problem to adapt to prison life. It has to do with the foods that they give to them. They are used to their cultural diet at home. In prisons, they eat all foods that the authorities give to all the inmates. This behaviour makes some inmates cook or prepare their dishes that affect their meagre economy in prison. Thus, this lack of understanding concerning the cultural problems and their inability to adapt to prison life makes the immigrant inmates all the more miserable in prison.

Predictive Value of Welfare Careers on Adaptation in Prisons
Regression is an important method to study the relationship between variables and for making predictions of likely values of the dependent variable. It is the most extensively used method for conducting multivariate analyses, particularly when more than three variables are involved. In Tables 2&3, multiple regression analyses were employed to find the significant predictors of changes in attitudes and behaviours of inmates. The simple stepwise multiple regression analyses were performed using two groups of independent variables. In the first place, in Table   2, the variable changes in attitudes and behaviours were used as dependent variables while religious affiliation, church attendance, religious service observance, motivation and support, deeply felt positive mood and age was employed as independent variables. The explained variance was 29% and the unexplained variance was 71%. The findings of this multivariate regression analysis showed the usefulness of the chaplains' work as having significant predictive power about changes in attitudes and behavior (B coefficient = 0.80).

Discussion and Direction for Future Research
The study commenced with a general proposition that the chaplain's/carers' work will have influenced the attitudes and While making use of their experiences with inmates is prohibited, according to the professional code, these carers cannot forget the effects of some of these bad experiences that happened to the inmates. The carers do not display the worries of the bad experiences publicly. On the contrary, the carers feel them deep inside as they go about their work. These social problems concern the problems with the criminal justice system, problems with their culture, drug offense problems and sentencing, and many others. There is a need for a chaplain in this prison. The present study indicates that the chaplains' work associates with attitudes and behavioural change that immigrant inmates experience in prison.
This behaviour symbolizes the great work of healthcare they do in the prisons. This change may be the cause why some inmates do not consider committing suicide but can cope with life and the difficulties they face in the prison environment. Previous church attendance before imprisonment may help very little as compared with the chaplains' functions. Together with the mood positivity of the inmates (which results from the chaplains' work), these can make inmates live happily in prisons forgetting now and then their troubles. Inmates also give up that behaviour that does not help them to cope or adjust. The two predictive factors, the usefulness of the chaplain's work and deeply felt positive mood tell us that the work of the carers in prison is significant not only to the public healthcare but also to the inmates coping strategy.

Ethics Declarations
Ethics approval and consent to participate: Permission was given to the researcher by the Swedish Agency that deals with Kriminalvarden and the National Crime and Probation Administration. Therefore, I acquired permission. Moreover, I tried to hide the identities of the individuals. Informed Consent and Anonymity complied.

Consent for Publication
Not applicable