| 1. |
- Abbasi, Seyed
(författare)
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Determinants of social inequalities in cardiovascular disease among Iranian patients
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives: Cardiovascular disease (CVD) is the single largest cause of mortality in the world. Similar to other health issues, CVD is generally affected either by individual risk factors, which may influence the risk for developing an illness or its complications, or by social indicators (social determinants of health). There is evidence from developed countries which shows that the so-called "upstream factors"—including social determinants such as political, social, spiritual, cultural, and economic factors—may affect the prevalence and incidence of CVD. Scarce evidence from studies in low- and middle-income countries also suggests that social factors may affect the distribution of CVD across population groups. However, there is a dearth of such data in Iran, where only a few small-sizedstudies have focused on the social determinants of health. Therefore, the present thesis sought to fill this gap by assessing the effects of socioeconomic status (SES) on the distribution of CVD and the relevant inequalities within the Iranian context.Methods: This thesis is based on four studies, which used data from the Tehran Heart Center’s Databases. In Study I, a total of 44,820 patients who underwent coronary angiography at Tehran Heart Center between 2005 and 2010 were recruited. Then, their pre- and post-procedural data—including demographics, CVD risk factors, symptoms, and laboratory tests—were compared between men and women. In Study II, 6,246 patients with acutecoronary syndrome who were hospitalized between March 2004 and August 2011 were included and, based on their education and their employment status, were divided into high- and low-SES groups. Thereafter, the effect of SES on the in-hospital death of the patients was evaluated. In Study III, 20,165 patients with documented coronary artery disease who underwent coronary angiography at Tehran Heart Center were enrolled and CVD risk factors and severity (measured by the Gensini score) were assessed among the six major Iranian ethnic groups. In Study IV, 9,088 patients with acute coronary syndrome who were hospitalized at Tehran Heart Center between May 2007and June 2014 were recruited and the association between in-hospital death due to acute coronary syndrome and place of residence (rural/urban) was assessed using logistic regression adjusted for potential confounders.Results: In this thesis, the data analyses were based on the hypothesis that there is a potential association between the different socioeconomic indicators and the selected cardiovascular outcomes. In Study I, among the recruited participant, 25,363 men and 11,995 women had coronary artery disease and the women not only were significantly older, less educated, and more overweight but also had higher blood levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar than the men. Moreover, hypertension and diabetes mellitus showed the strongest association in the women with coronary artery disease (OR=3.45, 95% CI: 3.28to 3.61 and OR=2.37, 95% CI: 2.26 to 2.48, respectively). In addition, the frequency of post-procedural recommendations for non-invasive procedures was higher in the women than in the men (20.1% vs 18.6%; P<0.001). In StudyII, of the 6,246 recruited patients with acute coronary syndrome, 3,290individuals were considered low-SES and 2,956 high-SES individuals. In-hospital death occurred in 79 (1.26%) patients: 1.9% in the low-SES and 0.6% in the high-SES groups. After adjustment for the possible cofounders, our multivariate analysis demonstrated a significant effect of the patients’ SES on their in-hospital death and a lower in-hospital mortality rate was shown in the high-SES patients (OR=0.30, 95% CI: 0.09 to 0.98; P=0.046). In Study III, the Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest frequency of having at least four simultaneous risk factors. Additionally, the mean Gensini score was lowest in the Lurs (67.5±52.8) and highest among the Gilaks (77.1±55.9). The multivariable regression analysis indicated that the Gilaks showed the worst CVD severity (β: 0.056, 95% CI: 0.009 to 0.102; P=0.018), followed by the Turks (β: 0.032, 95% CI: 0.005 to 0.059; P=0.020), and the lowest CVD severity, was detected in the Lurs (β: -0.087, 95% CI: -0.146 to -0.027;P=0.004). Study IV showed that while smoking (P=0.002), positive family history of coronary artery disease (P=0.003), higher body mass index (P=0.013),and hyperlipidemia (P=0.026) were more prevalent in the urban patients, the rural patients showed lower educational levels (P<0.001) and higher frequency of unemployment (P=0.009). Meanwhile, in-hospital death occurred in 135 (1.5%) patients: 125 (1.5%) urban and 10 (1.2%) rural. To adjust the effects of the possible confounders, we utilized the Firth regression model, which showed no significant difference regarding in-hospital death betweenthe rural and urban patients (OR=1.57, 95% CI: 0.376 to 7.450; P=0.585).Conclusions: The aim of this thesis was to investigate the effects of social determinants (particularly SES) on CVD and its modifiable risk factors among Iranian patients. Results showed that medical treatment for CVD was more recommended (by treating physicians) to the women than the men, and the low-SES patients with acute coronary syndrome were more likely to die in the hospital than their high-SES counterparts. In addition, the thesis found heterogeneity in the distribution of the traditional risk factors for CVD as well as CVD severity in the major Iranian ethnic groups. Further, there were no differences concerning the in-hospital death rates due to acute coronary syndrome between the urban and rural patients after adjustment for the potential confounders.
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| 2. |
- Abbasi, Seyed H, et al.
(författare)
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Ethnic differences in the risk factors and severity of coronary artery disease : a patient-based study in Iran
- 2018
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Ingår i: Journal of Racial and Ethnic Health Disparities. - : Springer Berlin/Heidelberg. - 2197-3792 .- 2196-8837. ; 5:3, s. 623-631
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Tidskriftsartikel (refereegranskat)abstract
- Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.
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| 3. |
- Abbasi, Seyed H, et al.
(författare)
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Gender Differences in the Risk of Coronary Artery Disease in Iran
- 2012
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Ingår i: Iranian Journal of Public Health. - 0304-4556. ; 41:3, s. 36-47
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Tidskriftsartikel (refereegranskat)abstract
- Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.
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| 4. |
- Abbasi, Seyed Hesameddin, et al.
(författare)
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Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?
- 2022
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Ingår i: Journal of Teheran University Heart Center. - : Tehran University of Medical Sciences. - 1735-8620 .- 2008-2371. ; 17:2, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment.Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders.Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585).Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.
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| 5. |
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| 6. |
- Abbasi, Seyed, et al.
(författare)
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Socioeconomic status and in hospital mortality of acute corony syndrome: Can education and occupation serves as preventive measures?
- 2015
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Ingår i: International Journal of Preventive Medicine. - : Medknow. - 2008-7802 .- 2008-8213. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.
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| 7. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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A qualitative study of factors that managers in small companies consider important for their wellbeing
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- PurposeGiven the importance of small businesses for society, and the significance of managers’ wellbeing for employee health, leadership, and business performance, more knowledge is needed on the sources of managers’ wellbeing. This study explored factors within the small business context that were perceived by managers to hinder or enable their wellbeing.MethodsData were collected through qualitative semi-structured interviews with 20 managers from 12 small companies, and analysed with content analysis.ResultsThe factors that these managers in small businesses experienced as enhancing or hindering their personal wellbeing covered five categories: demands and resources in the daily managerial work, achievement of results, social factors, organizational factors, and individual factors.ConclusionsThe specific context of managerial work in small companies encompasses unique factors. For instance, the small company managers’ wellbeing was affected by vulnerability due to the smallness of the business and the absence of available resources. Simultaneously, a small company context provided a strong social climate and close relationships with employees and customers that strengthened the managers’ wellbeing. The findings suggest that the availability of financial, personnel, and organizational resources varies between small companies of different size, which may have implications for small business managers’ work and wellbeing.
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| 8. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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FRAMFÖR (Framgångsrika företag i Gästrikland) : ett longitudinellt projekt om ledarskap, arbetsmiljö och effektivitet – fördel för både forskning, utbildning och ett hållbart arbetsliv?
- 2016
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Ingår i: Inkluderande och hållbart arbetsliv. - Östersund : Mittuniversitetet. ; , s. 48-48
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Konferensbidrag (refereegranskat)abstract
- Projektbeskrivning: FRAMFÖR har under 15 år bedrivits i Gästrikland i samarbete mellan utbildning och forskning vid Högskolan i Gävle, företagsutvecklare vid kommuner, företag och näringslivsorganisationer. Varje år delas utmärkelsen FRAMFÖR ut till 50 företag. Ambitionen är att uppmuntra framgångsrika företagare och visa upp intressanta exempel på hur framgång kan skapas. Processen startar med att 120 företag (>4 anställda) nomineras utifrån finansiella kriterier (ex. omsättningstillväxt, vinstmarginal). Sedan genomför studenter vid Ekonomprogrammet intervjuer med cheferna för dessa företag. Intervjuerna sker utifrån ett standardiserat frågeformulär kring arbetsmiljö, ledarskap, organisering och effektivitet. Avslutningsvis väljer en jury ut de 50 mest framgångsrika företagen utifrån såväl finansiella kriterier som studenternas intervjuresultat. Projektets trippel helixuppbyggnad (Utbildning, Forskning och, Företag) skapar nyttor för olika intressenter.Utbildningsnyttor: Studenterna får möjlighet till interaktion med företagare i sin direkta närhet. Aktiviteterna underlättar att uppfylla utbildningsmål där flera mål kan uppfyllas med samma aktiviteter. Förståelse för näringslivets förutsättningar samt kunskaper om ett vetenskapligt angreppssätt ökar.Forskningsnyttor: Stärker pågående forskning om hälsofrämjande och effektivt ledarskap inom arbetshälsovetenskap samt företagsutveckling inom företagsekonomi. Det stora urvalet av företag ger en bra bild av företagen i regionen och en möjlighet att följa dem över tid. Ambitionen är att få mer kunskap om hållbara och effektiva företag. Fördjupade studier av utmärkelseföretag möjliggörs och ett doktorandprojekt med inriktning på ledarskapsbeteenden, organisationsfaktorer, tidsanvändning samt chefers/medarbetares arbetsmiljö/hälsa i utmärkelseföretag är uppstartat.Företagsnyttor: Företagare får möta studenter och förstå hur de tänker. Ställda frågor, t.ex. rörande arbetsmiljö och ledarskap, kan starta reflektionsprocesser som bidrar till fortsatt utveckling. FRAMFÖR-utmärkelsen delas ut vid en högtidlig tillställning där företagarna kan bygga nätverk. Flera företagare lyfter fram det positiva symbolvärdet av att få utmärkelsen.Projektets framtid: Målet är att fortsätta ytterligare 15 år och fortsätta utveckla nyttorna för samtliga intressenter. Ett prioriterat område är återkoppling till företag i någon form samt ökad samverkan mellan studenter och företagare.
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| 9. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers’ and employees’ experiences of how managers’ wellbeing impacts their leadership behaviours in Swedish small businesses
- 2023
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 75:1, s. 97-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:There is a growing interest in managers’ wellbeing due to the observed associations between their wellbeing and leadership behaviours, and between leadership behaviours and employees’ wellbeing. However, it is still unclear how managers’ wellbeing influences their practiced leadership across different workplace contexts, which specific behaviours are affected, and how this varies across time.OBJECTIVE:The purpose of this study was therefore to explore managers’ and employees’ experiences and perceptions regarding the consequences of managers’ wellbeing for their leadership behaviours in small businesses.METHODS:Semi-structured interviews were conducted with 37 participants (19 managers and 18 employees) working at 12 Swedish small firms, and analysed using content analysis.RESULTS:The findings show that managers were more constructive when they felt well, and more passively destructive when unwell. Variations in managers’ wellbeing influenced their mood, energy level, and performance, as well as the company’s working climate. However, these destructive leadership variations did not have a substantial impact, because several protective factors were present.CONCLUSION:This study shows that the wellbeing of managers in small businesses has perceptible consequences for their leadership behaviours. The study also shows that sustained leadership behaviours may coexist with temporary variations of these behaviours on a constructive-destructive continuum depending on the leader’s wellbeing. Overall, the findings contribute to a more nuanced and dynamic understanding of how the interaction between managers’ wellbeing and their behaviours unfolds in the particular context of small companies.
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| 10. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers in the context of small business growth: a qualitative study of working conditions and wellbeing
- 2024
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Ingår i: BMC Public Health. - : Springer. - 1471-2458. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- PurposeIn view of the importance of managers’ wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers’ wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers’ wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth.MethodsThe study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied.ResultsThe findings indicate that a manager’s working environment evolves from its initial stages and through the company’s growth, leading to variations over time in the manager’s experiences of wellbeing and work–life balance as well as changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work–life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers’ increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers’ wellbeing.ConclusionsThis study shows that, in the context of small business, managers’ working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers’ working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.
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