| 1. |
- Ahnquist, Johanna, et al.
(författare)
-
Economic hardships in adulthood and mental health in Sweden. the Swedish National Public Health Survey 2009
- 2011
-
Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Possible accumulative effects of a combined economic hardship's measure, including both income and non-income related economic hardships measures, on mental health has not been well investigated. The aim of this paper was to investigate; (i) independent associations between multiple measures of economic hardships and mental health problems, and (ii) associations between a combined economic hardships measure and mental health problems. Methods: We analysed data from the 2009 Swedish National Survey of Public Health comprising a randomly selected representative national sample combined with a randomly selected supplementary sample from four county councils and three municipalities consisting of 23,153 men and 28,261 women aged 16-84 years. Mental health problems included; psychological distress (GHQ-12), severe anxiety and use of antidepressant medication. Economic hardship was measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Results: The results from multivariate adjusted (age, country of birth, educational level, occupational status, employment status, family status and long term illness) logistic regression analysis indicate that self-reported current economic difficulties (inability to pay for ordinary bills and lack of cash reserves), were significantly associated with both women's and men's mental health problems (all indicators), while low income was not. In addition, we found a statistically significant graded association between mental health problems and levels of economic hardships. Conclusions: The findings indicate that indicators of self-reported current economic difficulties seem to be more strongly associated with poor mental health outcomes than the more conventional measure low income. Furthermore, the likelihood of mental health problems differed significantly in a graded fashion in relation to levels of economic hardships.
|
|
| 2. |
- Ahnquist, Johanna, et al.
(författare)
-
Social determinants of health - A question of social or economic capital? Interaction effects of socioeconomic factors on health outcomes
- 2012
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 74:6, s. 930-939
-
Tidskriftsartikel (refereegranskat)abstract
- Social structures and socioeconomic patterns are the major determinants of population health. However, very few previous studies have simultaneously analysed the "social" and the "economic" indicators when addressing social determinants of health. We focus on the relevance of economic and social capital as health determinants by analysing various indicators. The aim of this paper was to analyse independent associations, and interactions, of lack of economic capital (economic hardships) and social capital (social participation, interpersonal and political/institutional trust) on various health outcomes. Data was derived from the 2009 Swedish National Survey of Public Health, based on a randomly selected representative sample of 23,153 men and 28,261 women aged 16-84 year, with a participation rate of 53.8%. Economic hardships were measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves. Social capital was measured by social participation, interpersonal (horizontal) trust and political (vertical/institutional trust) trust in parliament. Health outcomes included; (i) self-rated health, (i) psychological distress (GHQ-12) and (iii) musculoskeletal disorders. Results from multivariate logistic regression show that both measures of economic capital and low social capital were significantly associated with poor health status, with only a few exceptions. Significant interactive effects measured as synergy index were observed between economic hardships and all various types of social capital. The synergy indices ranged from 1.4 to 2.3. The present study adds to the evidence that both economic hardships and social capital contribute to a range of different health outcomes. Furthermore, when combined they potentiate the risk of poor health. (C) 2012 Elsevier Ltd. All rights reserved.
|
|
| 3. |
- Ahnquist, Johanna, et al.
(författare)
-
What has trust in the health-care system got to do with psychological distress? Analyses from the national Swedish survey of public health
- 2010
-
Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 22:4, s. 250-258
-
Tidskriftsartikel (refereegranskat)abstract
- Mental health disorders are a rapidly growing public health problem. Despite the fact that lack of trust in the health-care system is considered to be an important determinant of health, there is scarcity of empirical evidence demonstrating its associations with health outcomes. This is the first study which aims to evaluate the association between trust in the health-care system and psychological distress. Cross-sectional study. The association between trust in the health-care system and psychological distress was analysed with multiple logistic regression analysis adjusting for other factors. A randomly selected representative sample of women and men aged 16-84 years from the Swedish population who responded to the 2006 Swedish National Survey of Public Health. A total of 26 305 men and 30 584 women participated in the study. None. The main outcome measure was psychological distress measured by the General Health Questionnaire. Very low trust in health-care services was associated with an increased risk for psychological distress among men (odds ratio = 1.59, 95% confidence intervals 1.25-2.02) and among women (odds ratio = 1.83, 95% confidence intervals 1.47-2.27) after controlling for age, country of birth, socioeconomic circumstances, long-term illness and interpersonal trust. Our results suggest that health-care system mistrust is associated with an increased likelihood of psychological distress. Although causal relationships cannot be established, patient mistrust of health-care providers may have detrimental implications on health. Public health policies should include strategies aimed at increasing access to health-care services, where trust plays a substantial role.
|
|
| 4. |
- Deogan, Charlotte L., et al.
(författare)
-
A cost-effectiveness analysis of the Chlamydia Monday A community-based intervention to decrease the prevalence of chlamydia in Sweden
- 2010
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 38:2, s. 141-150
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. Methods: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. Results: Total costs were calculated to be (sic)66,787.21; total savings to (sic)30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was (sic)8,346.05 ((sic)10,810.77/QALY for women and (sic)6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than (sic)50,000, which is often regarded as cost-effective in a Swedish context. Conclusions: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society's resources.
|
|
| 5. |
- Karim, KM Rabiul, et al.
(författare)
-
Water development projects and marital violence : experiences from rural Bangladesh
- 2012
-
Ingår i: Health Care for Women International. - : Informa UK Limited. - 0739-9332 .- 1096-4665. ; 33:3, s. 200-216
-
Tidskriftsartikel (refereegranskat)abstract
- In this study, we explored the implications of a groundwater development project on women's workload and their experience of marital violence in a Bangladesh village. We believe that the project facilitated irrigation water but also that it resulted in seasonal domestic water shortages. Men used deep motorized pumps for irrigation, and women used shallow handpumps for domestic purposes. Many handpumps dried out, so women had to walk to distant wells. This increased their workload and challenged their possibilities of fulfilling household obligations, thereby increasing the risk of normative marital male violence against women as a punishment for their failure.
|
|
| 6. |
- Lindholm, C., et al.
(författare)
-
Income distribution and mortality in Sweden
- 2008
-
Ingår i: Italian Journal of Public Health. - 1723-7807 .- 1723-7815. ; 5:4, s. 304-309
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The hypothesis that a high income inequality on a societal level is associated with poor health outcomes has been both rejected and accepted in empirical studies. Whether the influence of economic circumstances on health operates at the individual level or societal level has important implications on policy and intervention alternatives. The objective of this study was to analyse the relationship between income inequality and mortality in Swedish municipalities and if the relationship varies depending on the mean income or on the time-lag between income inequality and mortality. Methods: The study was based on register data on mean income and income inequality (Gini coefficients) from Statistics Sweden 1982 and 1998, aggregated on the municipality level. Data on age-standardised death rates per 100,000 persons were obtained for 1983, 1988, 1993, 1998 and 2002. The analysis on 1998 was a test of the robustness of the results. Results: The relationship between high income inequality in 1982 and mortality in 1983 was negative with a similar relationship in 1998. Using latency periods, the results show a decreasing trend of mortality in relation to higher Gini coefficients. A positive relationship between Gini and mean income implies that municipalities with larger income distribution also had a higher mean income and vice versa. Conclusions: High income inequality does not have a negative effect on mortality in Swedish municipalities. The municipalities with high income inequality have also high mean income as opposed to many other countries. The income level seems to be more substantial for mortality than the income inequality.
|
|
| 7. |
|
|
| 8. |
- Wamala, Sarah P
(författare)
-
Socioeconomic status and cardiovascular vulnerability in women : psychosocial, behavioral and biological mediators
- 1999
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiovascular disease (CVD) is the leading cause of death in both men and women in the industrialized world, and represents a major health and economic burden. Coronary heart disease (CHD), one of the most common of the cardiovascular diseases, is invariably more frequent in men and women of lower than higher socioeconomic status (SES). In spite of the overall decline in CHD rates, socioeconomic differences persist, and may even be widening, particularly in women. Most studies of SES and CHD have been done in men, and relatively little is known about the socioeconomic determinants of CHD risk in women. Studying SES and CHD in women is even more important than in men, because the attributable fraction of low SES for CVD, may be higher in women due to their more disadvantaged socioeconomic position. Aims of the study: 1) To study the association between SES and CHD development in women, 2) To estimate the relative contribution of social and behavioral factors to the socioeconomic disparities in women's CHD, 3) To study the effects of SES and childhood circumstances on CHD prognosis in women, and 4) To study the associations between SES and physiological risk factors for CHD (obesity, atherogenic lipid profile and hemostatic dysfunction) in women. Material and Methods: This is the first doctoral thesis which is based on data from the Stockholm Female Coronary Risk (FemCorRisk) Study. The FemCorRisk study is a population-based case-control study which comprises all women aged 65 years or younger who were admitted for an acute event of CHD between 1991 and 1994 in any of the coronary care units of all hospitals in the greater Stockholm area. Healthy controls from the census register were matched with CHD patients with regard to age and catchment area. To study the association between SES and CHD development, case-control analyses were done. To study the effects of SES and childhood circumstances on CHD prognosis, CHD patients were followed for 5-years after an acute event of CHD. Deaths from CHD, recurrent acute myocardial infarctions, and revascularizations were monitored. To study the associations between SES and physiological risk factors, cross-sectional analyses of the population-based healthy women (control-group) of the FemCorRisk Study were done. Results: Low SES increases vulnerability to CHD in women. Low SES (as measured by low educational attainment and low occupational status) had a substantial impact on both cardiovascular risk, and physiological risk factors for CHD (obesity, atherogenic lipid profile and hemostatic dysfunction). After adjustment for age, women with only mandatory school education (<9 years) had a two-fold increased risk for CHD as compared to women who had attained college/university. Psychosocial stress, unhealthy behaviors and poorer physiological risk factor profiles explained the association between low education and increased CHD risk. Of these factors, psychosocial stress and unhealthy behaviors were the most important. Un/semiskilled workers had a four-fold increased risk for CHD as compared to executives/professionals, after adjustment for age. Traditional cardiovascular risk factors and work-related factors however, explained "only in part" why women with lower status jobs had an increased risk of CHD. The impact of low SES on a poorer prognosis of CHD, was unclear, but adverse childhood circumstances (as measured by short stature), showed a strong negative effect on CHD prognosis. In healthy women, low SES was associated with obesity, atherogenic lipid profile (mainly low HDL) and hemostatic dysfunction. Conclusions: Findings in this thesis underline the importance of low SES in the etiology of CHD in women. The factors explaining the CHD-SES association in women range from adverse childhood circumstances, individual personality, social relations, health behaviors, biological risk factor profiles, to stressors that operate both at work and at home. Because of the structural positions that women occupy in society, one of the challenges for future preventive efforts is to create favorable conditions for socioeconomically deprived women. Such efforts should combine both work and non-work-related factors.
|
|
