| 41. |
- Wahlström, R, et al.
(författare)
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Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices
- 2004
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Ingår i: Scandinavian journal of public health. Supplement. - : SAGE Publications. - 1403-4956 .- 1403-4948 .- 1651-1905. ; 63, s. 222-55
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Tidskriftsartikel (refereegranskat)abstract
- Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.
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| 42. |
- Aaro, LE, et al.
(författare)
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Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme
- 2006
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:2, s. 150-158
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Action to prevent the spread of HIV among young people in Sub-Saharan Africa is needed urgently. In order to be effective, such action should be theory and evidence based and carefully adapted to local cultures and contexts. The present article describes the organization, theoretical basis, and methodological approach of a project that aims at developing and evaluating school-based interventions targeting adolescents aged 12—14 years. Methods: Researchers from European and African universities have developed interventions that were conducted in three sites: Cape Town and Polokwane (South Africa) and Dar es Salaam (Tanzania). In each site the interventions were evaluated through large-scale field experiments with intervention schools and delayed intervention schools and with baseline and two follow-up data collections. Mimimum sample sizes were estimated for each site based on local data and taking into acount that the unit of allocation was schools and not individual students (the design effect). During the formative phase as well as within the field experiments, qualitative studies were also conducted. Discussion: The interventions were developed consistent with the Intervention Mapping approach, and the theoretical framework was based on a modified version of the Theory of Planned Behaviour. The limitations of Western social cognition models were recognized, and the theoretical framework has therefore been expanded in two directions: towards integrating cultural processes and towards taking societal factors and constraints into account. Conclusion: The project will throw light on the application of social cognition models as well as the usefulness of the Intervention Mapping approach to intervention development in sub-Saharan Africa.
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| 43. |
- af Sillén, Ulrika, et al.
(författare)
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Self-rated health in relation to age and gender: influence on mortality risk in the Malmö Preventive Project.
- 2005
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 33:3, s. 9-183
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Tidskriftsartikel (refereegranskat)abstract
- Aims: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. Subjects and methods: Data are derived from a population-based study in Malmo¨ , Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. Results: At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4–1.7), and for women HR 1.4 (1.2–1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1–1.4), and women HR 1.1 (0.9–1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1–1.3). Conclusion: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events.
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| 44. |
- Agardh, Emilie E., et al.
(författare)
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Alcohol and type 2 diabetes : The role of socioeconomic, lifestyle and psychosocial factors
- 2019
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 47:4, s. 408-416
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: We investigate (a) alcohol consumption in association with type 2 diabetes, taking heavy episodic drinking (HED), socioeconomic, health and lifestyle, and psychosocial factors into account, and (b) whether a seemingly protective effect of moderate alcohol consumption on type 2 diabetes persists when stratified by occupational position.METHODS: This population-based longitudinal cohort study comprises 16,223 Swedes aged 18-84 years who answered questionnaires about lifestyle, including alcohol consumption in 2002, and who were followed-up for self-reported or register-based diabetes in 2003-2011. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated in a multivariable-adjusted logistic regression model for all participants and stratified by high and low occupational position. We adjusted for HED, socioeconomic (occupational position, cohabiting status and unemployment), health and lifestyle (body mass index (BMI), blood pressure, smoking, physical inactivity, poor general health, anxiety/depression and psychosocial (low job control and poor social support) characteristics one by one, and the sets of these factors.RESULTS: Moderate consumption was inversely associated with type 2 diabetes after controlling for health and lifestyle (OR=0.47; 95% CI: 0.29-0.79) and psychosocial factors (OR=0.40; 95% CI: 0.22-0.79) when compared to non-drinkers. When adjusting for socioeconomic factors, there was still an inverse but non-significant association (OR=0.59; 95% CI: 0.35-1.00). In those with high occupational position, there was no significant association between moderate consumption and type 2 diabetes after adjusting for socioeconomic (OR=0.67; 95% CI: 0.3-1.52), health and lifestyle (OR=0.70; 95% CI: 0.32-1.5), and psychosocial factors (OR=0.75; 95% CI: 0.23-2.46). On the contrary, in those with low occupational position, ORs decreased from 0.55 (95% CI: 0.28-1.1) to 0.35 (95% CI: 0.15-0.82) when adjusting for psychosocial factors, a decrease that was solely due to low job control. HED did not influence any of these associations.CONCLUSIONS: Moderate alcohol consumption is associated with a lower risk of type 2 diabetes, after adjusting for HED, health and lifestyle, and psychosocial characteristics. The association was inverse but non-significant after adjusting for socioeconomic factors. When stratified by occupational position, there was an inverse association only in those with low occupational position and after adjusting for low job control.
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| 45. |
- Agardh, EE, et al.
(författare)
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The magnitude of bias in a cross-sectional study on lifestyle factors in relation to Type 2 diabetes
- 2006
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:6, s. 665-668
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Tidskriftsartikel (refereegranskat)abstract
- Aim: In cross-sectional studies it may be difficult to ascertain the temporal order of exposure and disease, which may have consequences for causal inference. The authors aimed to illustrate the possible magnitude of this potential bias using data from a cross-sectional study on coffee consumption and work stress in relation to type 2 diabetes. Methods: By a series of computer simulations the authors examined to what extent the observed negative association between type 2 diabetes and high coffee consumption and positive association between type 2 diabetes and high work stress could be due to reverse causality, by assuming that cases changed their exposures in response to development of the disease. Results: If the negative association between coffee and type 2 diabetes was a consequence of reversed causality, 30—40% of the cases would have to decrease their coffee consumption from≥5 cups of coffee per day to 3—4 cups per day and from 3—4 cups per day to≤2 cups of coffee per day. Moreover, approximately 60% of the cases would have to increase their work stress from low to medium work stress and from medium to high work stress, in order to produce the positive association with diabetes that was observed. Conclusion: Even if the type 2 diabetic patients to some extent may have changed their exposure in response to disease development, it seems unlikely that the associations observed between type 2 diabetes, coffee consumption, and work stress are due to this bias.
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| 46. |
- Agerholm, J, et al.
(författare)
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Socioeconomic differences in healthcare utilization, with and without adjustment for need: an example from Stockholm, Sweden
- 2013
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 41:3, s. 318-325
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Previous studies have shown varying degrees of inequity of utilization of healthcare in Sweden. Studies based solely on register data cannot take into account differences in health status while studies based solely on self-reported data from surveys may potentially have biased data on healthcare utilization. The aim of this study was to investigate socioeconomic differences in utilization of outpatient healthcare services in Stockholm County, comparing analysis based on only register data, with analysis based on health survey data linked to register data. Methods: We linked data from a public health survey in Stockholm County 2006 ( n = 34,707) to register data on sociodemographic background characteristics and outpatient healthcare utilization in 2007. Negative binomial regression analysis was used to estimate income differentials in healthcare utilization adjusting for self-rated health and limiting longstanding illness. Results: Income differentials in the number of visits to doctors were found in favour of lower-income groups among people aged 25–64 years when only controlling for age. When controlling for health status, income differentials in favour of higher-income groups were observed among men (all ages) and among women aged 65+ years, with higher-income groups having 11–49% more visits than the lowest income group. Conclusions: The findings suggest that health status should be taken into account when analysing socioeconomic differences in healthcare utilization. When using only register based data there is a risk of underestimating or disregarding differences.
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| 47. |
- Agerholm, Janne, et al.
(författare)
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The organisation and responsibility for care for older people in Denmark, Finland and Sweden : outline and comparison of care systems
- 2024
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 52:2, s. 119-122
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To outline the organisation and responsibility for health and social care provided to older people in Denmark, Finland and Sweden.Methods: Non-quantifiable data on the care systems were collated from the literature and expert consultations. The responsibilities for primary healthcare, specialised healthcare, prevention and health promotion, rehabilitation, and social care were presented in relation to policy guidance, funding and organisation.Results: In all three countries, the state issues policy and to some extent co-funds the largely decentralised systems; in Denmark and Sweden the regions and municipalities organise the provision of care services – a system that is also about to be implemented in Finland to improve care coordination and make access more equal. Care for older citizens focuses to a large extent on enabling them to live independently in their own homes.Conclusions: Decentralised care systems are challenged by considerable local variations, possibly jeopardising care equity. State-level decision and policy makers need to be aware of these challenges and monitor developments to prevent further health and social care disparities in the ageing population.
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| 48. |
- Aglen, B., et al.
(författare)
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Self-help and self-help groups for people with long-lasting health problems or mental health difficulties in a Nordic context : A review
- 2011
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 39:8, s. 813-822
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Forskningsöversikt (refereegranskat)abstract
- Aim: The aim of this review is to provide systematic knowledge of research from Nordic countries about the meaning of self-help and self-help groups when these are used as a concept or method addressing issues related to long-lasting health problems or mental health difficulties. Methods: Included were studies conducted in the Nordic countries that were published between January 1999 and September 2009. These studies investigated self-help and self-help groups addressing issues related to long-lasting health problems. Results: A total of 83 publications met the inclusion criteria. Four major characteristics of self-help were found to be present in the publications: self-help as an intrapsychological process, self-help as an interpsychological or group process, self-help as a coping, individual learning or empowerment process, and self-help as an alternative or complement to medical treatment. Of the 83 studies, 72 publications used a professional treatment perspective for studying self-help and 11 publications used a perspective derived from alternative or complementary therapies. Conclusions: The review shows that most of the research on self-help and self-help groups for people with long-lasting health problems or disability is conducted with an interest to improve the professional healthcare system. That is, the health-promotion strategy is mainly considered in the framework of treatment or care settings. This means that self-help in this context does not challenge the dominant biomedical health model. © 2011 the Nordic Societies of Public Health.
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| 49. |
- Agren, G, et al.
(författare)
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Mortality trends for young adults in Sweden in the years 2000-2017
- 2022
-
Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 50:4, s. 448-453
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Tidskriftsartikel (refereegranskat)abstract
- Mental health problems in young people seem to be on the rise and more so in Sweden than in other locations. The aim was to compare the development of mortality rates for young adults in Sweden with Western Europe in total. Methods: Young adults were defined as individuals aged 20–34 years and the study period was 2000–2017. Mortality data were derived from the Institute of Health Metrics and Evaluation. Results: During the period 2000–2017, the mortality rate in young adults in Sweden stayed about the same, while in Western Europe as a whole the mortality rate decreased by 42%. The leading explanation for the unfavourable Swedish development was deaths due to drug use, mainly opioids, which increased by 60% during this period. The other major causes of death decreased both in Sweden and Western Europe, but decreased more slowly in Sweden. The differences in the rate of decrease between Sweden and Western Europe were for self-harm (27%), transport injuries (12%), unintentional injuries (31%) and for neoplasms (23%). The unfavourable development in Sweden resembled the development in the USA. Conclusions: The risks of four of the five leading causes of death in this age group were affected by the individuals’ social conditions. The unfavourable mortality development in young adults in Sweden was mainly due to substance use. A contributing cause might be the change in the Swedish healthcare system that introduced competition between providers, which might have encouraged providers to prescribe opioids.
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| 50. |
- Ahlborg, Tone, 1950, et al.
(författare)
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Sense of Coherence in first-time parents – a longitudinal study.
- 2013
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Ingår i: Scandinavian Journal of Public Health. - 1403-4948. ; 41:6, s. 623-629
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Tidskriftsartikel (refereegranskat)abstract
- Background: Antonovsky’s idea of sense of coherence (SOC) is related to wellbeing and is of importance for individuals in public health care. SOC in parents with healthy children has not previously been studied. The objectives of this study were (1) to describe the SOC of first-time parents during the first 8 years of their child’s life, (2) to describe gender differences in regards to SOC, and (3) to describe covariates with SOC in the parents’ life situations. Methods: The study was longitudinal comprising three cross-sectional studies conducted when the first child was 6 months (T1), 4 years (T2), and 8 years (T3) of age. A sample of 258 mothers and fathers answered a questionnaire on the experienced quality of their partner relationship (QDR36) on all three occasions. SOC was measured using the SOC-13, and psychosocial variables were included at T2 and T3. Descriptive, comparative statistics and multiple regression analyses were performed. Results: SOC decreased for both genders at T2 and increased again at T3. At T1 and T2 the fathers’ SOC was statistically higher than that of the mothers, but at T3 this difference could no longer be statistically secured. Covariates at T2 were QDR index, social support, experience of parenthood, strained economy, and health. Covariates at T3 were experience of parenthood and social support, QDR index, and strained economy. Conclusions: SOC in first-time parents decreased at 4 years, especially in mothers, and social support can be of significance for parents of young children to be able to experience health.
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