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| 5. |
- Macassa, Gloria, et al.
(författare)
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Trends in infant and child mortality in Mozambique during and after a period ofconflict
- 2003
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Ingår i: Public Health. - 0033-3506 .- 1476-5616. ; 117:4, s. 221-227
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Tidskriftsartikel (refereegranskat)abstract
- This study describes urban and rural trends of infant, child and under-five mortality in Mozambique (1973–1997) by mother's place of residence. A direct method of estimation was applied to the 1997 Mozambican Demographic and Health Survey data. The levels of infant, child and under-five mortality were considerably higher in rural than in urban areas. The difference in mortality between urban and rural areas increased over time until 1988–1992 and thereafter diminished. Possible causes of the different trends (e.g. the impact of civil war, drought, migration, adjustment programme and HIV/AIDS) are discussed. The increase in mortality in urban areas during the last few years before the survey may have been related to the immigration to urban areas of mothers whose children had high levels of mortality. Higher levels of infant, child and under-five mortality still prevail, particularly in rural areas. Further studies are needed to investigate the differentials of infant and child mortality by mother's place of residence.
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- Andersson, M. J., et al.
(författare)
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An interrupted time series analysis of gambling behavior based on gambling operator revenue-based taxation during the COVID-19 pandemic in Sweden
- 2022
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506. ; 211, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The impact of COVID-19 on gambling behavior and the gambling industry itself has been widely speculated. Prior studies have shown how boredom, social isolation, poor mental health, and financial hardships, all of which have been associated with COVID-19, can aggravate problem gambling behaviors in patients with gambling disorders while also luring newcomers. Few studies have used methods other than self-report to assess longitudinal behavioral changes in gambling behavior before versus during the pandemic. Study design: The present study addresses this gap by using an interrupted time series approach on data obtained from the Swedish Gambling Authority measuring taxation on gambling vendors' revenue between January 2019 and November 2021. Methods: March, June, and October 2020 were chosen as interruption points as they correspond to the pandemic's commencement, the return of elite sports, and the second wave of cases in Sweden, respectively. We hypothesized that the pandemic would be associated with both temporary changes for select gambling types and long-term increases in online gambling. Results: Results revealed the pandemic's onset was associated with transient effects at each point of interruption, as well as long-term upward trends in total gambling and commercial online gambling, excluding horse betting and the state-owned operator for online casinos and betting. Conclusions: The present study's findings, although consistent with the theory that gambling activity could increase during the pandemic, contradict previous studies that found no changes or a decrease from pre-COVID-19 levels. Findings indicate that the pandemic and Sweden's reaction to it were associated with increased use of some gambling products.
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- Asp, Margareta, professor, 1958-, et al.
(författare)
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Physical mobility, physical activity, and obesity among elderly : findings from a large population-based Swedish survey
- 2017
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Ingår i: Public Health. - : Elsevier B.V.. - 0033-3506 .- 1476-5616. ; 147, s. 84-91
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine how physical activity and physical mobility are related to obesity in the elderly. Study design A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%. Methods Obesity (body mass index ≥30 kg/m2) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses. Results The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14–3.75) than for physical inactivity (OR 1.63, 95% CI 1.28–2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility. Conclusion It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity.
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| 21. |
- Baburin, A., et al.
(författare)
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Avoidable mortality in Estonia : exploring the differences in life expectancy between Estonians and non-Estonians in 2005-2007
- 2011
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 125:11, s. 754-762
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: A considerable increase in social inequalities in mortality was observed in Eastern Europe during the post-communist transition. This study evaluated the contribution of avoidable causes of death to the difference in life expectancy between Estonians and non-Estonians in Estonia. Study design: Descriptive study. Methods: Temporary life expectancy (TLE) was calculated for Estonian and non-Estonian men and women aged 0-74 years in 2005-2007. The ethnic TLE gap was decomposed by age and cause of death (classified as preventable or treatable). Results: The TLE of non-Estonian men was 3.53 years less than that of Estonian men, and the TLE of non-Estonian women was 1.36 years less than that of Estonian women. Preventable causes of death contributed 2.19 years to the gap for men and 0.78 years to the gap for women, while treatable causes contributed 0.67 and 0.33 years, respectively. Cardiorespiratory conditions were the major treatable causes of death, with ischaemic heart disease alone contributing 0.29 and 0.08 years to the gap for men and women, respectively. Conditions related to alcohol and substance use represented the largest proportion of preventable causes of death. Conclusions: Inequalities in health behaviours underlie the ethnic TLE gap in Estonia, rather than inequalities in access to health care or the quality of health care. Public health interventions should prioritize primary prevention aimed at alcohol and substance use, and should be implemented in conjunction with wider social policy measures
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| 22. |
- Baigi, Amir, et al.
(författare)
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Cardiovascular mortality focusing on socio-economic influence : the low-risk population of Halland compared to the population of Sweden as a whole
- 2002
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Ingår i: Public Health. - Amsterdam : Elsevier. - 0033-3506 .- 1476-5616. ; 116:5, s. 285-288
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate the relationship between mortality from cardiovascular diseases (CVD) and socioeconomic status (SES) in Sweden and to estimate to what extent the difference between a province with low mortality and the rest of Sweden was dependent on socio-economic factors. A population-based retrospective study with a historical prospective approach was performed covering a 10-y period in the province of Halland, Sweden, as well as Sweden as a whole. Altogether 1654 744 men and 1592 467 women were included, of whom 45 394 men and 43 403 women were from Halland, distributed according to SES. Multivariate analysis with Poisson regression was used. Relative risks with 95% confidence intervals were calculated. Both men and women with a low SES showed a significantly higher risk of death from CVD in Sweden as a whole. The risk was 23% higher for male blue-collar workers and 44% higher for female blue-collar workers when compared to their white-collar counterparts. The level of mortality in Halland was 14% lower compared to the country as a whole when only age was taken into account. When the socio-economic variable was also included, this figure was 8%. The results show the substantial significance of social differences with respect to CVD mortality. The effect of SES seems to be more important than that of geographical conditions when the latter are isolated from socio-economic influence.
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| 25. |
- Bergh, Håkan, 1958, et al.
(författare)
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Life events, social support and sense of coherence among frequent attenders in primary health care.
- 2006
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Ingår i: Public health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 120, s. 229-236
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this survey was to compare stressful life events, social support and sense of coherence (SOC) between frequent attenders (FAs) and normal attenders (controls) in primary health care. STUDY DESIGN: A cross-sectional study was conducted in a primary healthcare centre in the south-west of Sweden. METHODS: A postal questionnaire was sent to 263 frequent attenders and 703 normal attenders. The questionnaire comprised sociodemographic variables and scales of stressful life events, social support and SOC. The results from the questionnaire were compared between the groups, and the significance of the variables in terms of attendance was tested in a multiple regression analysis. RESULTS: More of the FAs were secondarily single, they had more chronic diseases and were more often living on a sickness/disablement pension than the controls. FAs did not report more stressful life events than the controls nor was their experience of events more negative. Social support was as strong among FAs as among controls, and it had no significant effect on their frequent attendance. FAs had a significantly weaker SOC compared with controls. The variables that significantly influenced frequent attendance were high age [odds ratio (OR) = 1.02], chronic disease (OR = 3.08), sickness/disablement pension (OR = 2.46) and SOC (OR = 0.97). CONCLUSIONS: SOC had a significant influence on frequent attendance in primary health care, but stressful life events and social support did not. FAs did not report more stressful life events. However, due to an inadequate coping strategy, indicated by a weak SOC, the life events probably caused them more symptoms and diseases, and thereby a higher consulting frequency.
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| 26. |
- Bergh, Håkan, 1958, et al.
(författare)
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Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years.
- 2007
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Ingår i: Public health. - : Elsevier BV. - 0033-3506. ; 121:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To find predictive factors for long-term sick leave (SL) and disability pension (DP) among frequent attenders (FAs) and normal attenders (NAs) in primary health care. STUDY DESIGN: A cohort study with follow-up over 5 years. METHODS: Groups of FAs and NAs were followed over 5 years. Information about background, situation, sociodemography, life events, social support and sense of coherence were gathered at baseline. Multiple logistic regression analysis was used to determine the influence of each variable on long-term SL and receipt of a DP. RESULTS: During the study period, 18.9% of FAs received long-term SL/DP compared with 6% of NAs. Chronic disease was a predictive factor for long-term SL/DP among FAs [odds ratio (OR) 7.0] and NAs (OR 3.4). Among FAs, a life event was also a predictive factor (OR 2.1). Each additional life event increased the ratio of FAs with long-term SL/DP by 110%. Conflicts and losses had the greatest negative effects on FAs. CONCLUSIONS: FAs are a high-risk group for long-term SL/DP. Besides chronic disease, a life event was the only predictive factor for long-term SL/DP among FAs. These findings indicate that FAs are a vulnerable group for stressful events. Consequently, healthcare personnel should take more notice of life events among FAs.
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| 27. |
- Brinda, E. M., et al.
(författare)
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Socio-economic inequalities in health and health service use among older adults in India : results from the WHO Study on Global AGEing and adult health survey
- 2016
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506. ; 141, s. 32-41
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years. Study design This study is based on a population-based, cross-sectional survey. Methods We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality. Results About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH –0.122 (95% CI: –0.102; –0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health. Conclusion Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians.
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| 28. |
- Brynhildsen, Jan, et al.
(författare)
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Trends in body mass index during early pregnancy in Swedish women 1978-2001
- 2006
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 120:5, s. 393-399
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Tidskriftsartikel (refereegranskat)abstract
- Objective: to study the body mass index (BMI) in women seeking maternity health care during early pregnancy in Sweden, and to show trends for a period of more than 20 years. Study design: register study. Methods: data from the maternity health programme on consecutively delivered women in two Swedish hospitals were collected for the years 1978, 1986, 1992, 1997 and 2001. All women were weighed at their first midwife visit between 8 and 10 weeks of gestation and height was also measured. Results: data on 4883 women were collected. Data on weight were available for 4490 (92%) women and data on BMI were available for 4378 (90%) women. The age-adjusted average weight increased from 59.5 kg in 1978 to 68.2 kg in 2001, and the BMI increased from 21.7 in 1978 to 24.7 in 2001. In 2001, 38.6% of the women had a BMI >25 compared with 11.2 in 1978. In 2001, 11.6% of the women were obese compared with 2.2% in 1978. Conclusions: during the last two decades, an alarming increase in weight has occurred in Swedish women of childbearing age. © 2005.
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| 29. |
- Byass, Peter, et al.
(författare)
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Motherhood, migration and mortality in Dikgale : modelling life events among women in a rural South African community
- 2011
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Ingår i: Public Health. - London : Academic P.. - 0033-3506 .- 1476-5616. ; 125:5, s. 318-323
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Although particular types of life events in populations are often studied separately, this study investigated the joint effects of three major event types in South African women’s lives: motherhood, migration and mortality. Study design: Data were taken from a health and demographic surveillance site (HDSS) over an 11-year period, reflecting the entire population of a defined geographic area as an open cohort, in which individuals participated in regular longitudinal surveillance for health and demographic events. This HDSS is a member of the Indepth Network. Methods: Multivariate Poisson regression models were built for each of the three life event types, in which individual person-time observed out of the total possible 11-year period was used as a rate multiplier. These models were used to calculate adjusted incidence rate ratios for each factor. Results: In the 21,587 person–years observed for women aged 15–49 years, from 1996 to 2006, adjusted rate ratios for mortality and migration increased substantially over time, while motherhood remained fairly constant. Women who migrated were less likely to bear children; temporary migrants were at greater risk of dying, while permanent in-migrants had higher survival rates. Women who subsequently died were much less likely to bear children or migrate. Conclusions: The associations between motherhood, migration and mortality among these rural South African women were complex and dynamic. Extremely rapid increases in mortality over the period studied are presumed to reflect the effects of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Understanding these complex interactions between various life events at population level is crucial for effective public health planning and service delivery.
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| 30. |
- Byass, Peter, et al.
(författare)
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The role of demographic surveillance systems (DSS) in assessing the health of communities : an example from rural Ethiopia
- 2002
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 116:3, s. 145-150
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Tidskriftsartikel (refereegranskat)abstract
- Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.
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| 31. |
- Carlsson, Frida, et al.
(författare)
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Prevalence of annoyance attributed to electrical equipment and smells in a Swedish population, and relationship with subjective health and daily functioning
- 2005
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Ingår i: Public Health. - : Elsevier BV. - 1476-5616 .- 0033-3506. ; 119:7, s. 568-577
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-reported annoyance from electrical equipment has been in evidence since the mid-1980s, and the first reports of illness from everyday chemicals arose in the 1960s. However, the extent of the problem has not yet been fully established.AIMS: The aim of this study was to estimate the prevalence of annoyance related to electrical and chemical factors in a Swedish general population, and to assess possible relationships with subjective health and daily functioning.METHODS: In total, 13,604 subjects, representative of the population of Scania, Sweden, answered a survey containing five questions regarding annoyance from five environmental factors: fluorescent tube lighting, visual display units, other electrical equipment, air that smells of chemicals, and other smells. The survey also obtained data on self-reported health (SRH-7), mental well-being [General Health Questionnaire (GHQ)-12], work situation and daily functioning.RESULTS: Almost one-third of the respondents reported annoyance from at least one environmental factor. Annoyance was more frequent among women, subjects of working age and immigrants. Subjects who reported environmental annoyance scored higher on GHQ-12 and lower on SRH-7, indicating impaired subjective physical and mental well-being. They were also more likely to report deteriorated daily functioning.CONCLUSIONS: Annoyance related to electrical and/or chemical factors was common in a Swedish population. Subjects reporting environmental annoyance rated their overall health significantly poorer than the general population. The association with subjective health and functional capacity increased with severity of annoyance, which suggests that there is some connection between environmental annoyance, well-being and functional capacity.
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| 32. |
- Clark, Kristen D., Postdoctoral Fellow, et al.
(författare)
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Stressors in health care and their association to symptoms experienced by gender diverse people
- 2023
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 217, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesMany individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people.Study designThis study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey.MethodsComposite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims.ResultsA total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants.ConclusionsThe results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.
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| 33. |
- Costa, D., et al.
(författare)
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Male and female physical intimate partner violence and socio-economic position : a cross-sectional international multicentre study in Europe
- 2016
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Ingår i: Journal of Public Health. - UK : Elsevier. - 2198-1833 .- 1613-2238. ; 139, s. 44-52
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThis work explores the association between socio-economic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional).Study designCross-sectional international multicentre study.MethodsA sample of 3496 men and women, (aged 18–64 years), randomly selected from the general population of residents from six European cities was assessed: Athens; Budapest; London; Östersund; Porto; and Stuttgart. Their education (primary, secondary and university), occupation (upper white collar, lower white collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales.ResultsPast year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs university) was associated with female victimisation (adjusted odds ratio, 95% confidence interval: 3.2; 1.3–8.0) and with female bidirectional IPV (4.1, 2.4–7.1). Blue collar occupation (vs upper white) was associated with female victimisation (2.1, 1.1–4.0), female perpetration (3.0, 1.3–6.8) and female bidirectional IPV (4.0, 2.3–7.0). Unemployment duration was associated with male perpetration (>12 months of unemployment vs never unemployed: 3.8; 1.7–8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2–2.7; men: 1.7, 1.0–2.8).ConclusionsIn these European centres, physical IPV was associated with a disadvantaged SEP. A consistent socio-economic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions.
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| 35. |
- DeKeyser, Nicholas, et al.
(författare)
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Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women
- 2011
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Ingår i: Public Health. - : Elsevier Science B.V., Amsterdam. - 0033-3506 .- 1476-5616. ; 125:5, s. 311-317
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. Study design: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. Methods: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to less than7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros ((sic)). Results: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was (sic)1283 more per woman/ infant in the intervention group compared with the control group (P = 0.025). The degree of obesity at programme entry had no bearing on the outcome. Conclusions: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to less than7 kg, but had a higher total cost compared with standard antenatal care.
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| 36. |
- Dimberg, Lennart, 1947, et al.
(författare)
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Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men
- 2019
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506. ; 175, s. 148-155
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In this article, we present death and myocardial infarction (MI) incidences over 22 years in relation to possible risk factors and their explanatory value. Study design: In 1993, 980 middle-aged Swedish men in an automotive industry were surveyed at a health checkup as part of the Renault-Volvo Coeur project. The Swedish cohort was revisited in 2015. Methods: In 2015, incident MIs were identified using postal questionnaires, hospital records, and the Swedish national MI and death registers. The statistical results were given as odds ratios (ORs) and pseudo-R-2 (PR2), showing the proportion of variation in risk explained by logistic models. Results: One hundred and four deaths (4.6 per 1000 person-years) and 89 first MIs (4.2 per 1000 person-years) were identified. The Framingham risk index showed the strongest association with MI (OR = 23; 95% confidence interval [CI] = 5.42, 96.9), comparing the fifth quintile with the first. The all-cause death showed an OR of 3.2 (95% CI = 1.65, 6.08), with a suggested U-shape over quintiles. The percentages of PR2 for MI and death were 8.8% and 6.6%, respectively. All risk factors together explained 22% of the variation in risk of MI. Comparing mortality in men living alone with those married yielded an OR of 3.78, which was found to be statistically significant. The corresponding OR for MI was not significant. Conclusions: Traditional risk factors were confirmed but explained a modest proportion of the risk variation.
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| 37. |
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| 38. |
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| 39. |
- Elo, S L, et al.
(författare)
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Validity and utilization of epidemiological data: a study of ischaemic heart disease and coronary risk factors in a local population.
- 2009
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Ingår i: Public health. - : Elsevier BV. - 1476-5616 .- 0033-3506. ; 123:1, s. 52-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To calculate the burden of ischaemic heart disease (IHD) and coronary risk factors in a defined population using data from all public providers of health care, i.e. inpatient and outpatient care in all settings. STUDY DESIGN: Cross-sectional, 1-year retrospective study. METHODS: The main outcome measures were the number of individuals by diagnosis and by care setting, and gender- and age-specific event rates by diagnosis. RESULTS: Less than half of the individuals who visited any care provider for IHD or coronary risk factors were identified in the hospital discharge register. Calculation of the actual burden of disease in the population showed that when hospital discharge data were combined with outpatient data, there were no or slight differences in the age-specific rates of acute myocardial infarction (AMI), while the rates of angina were between two-fold and four-fold higher, and unspecified IHD was between three-fold and ten-fold higher in individuals aged > or =50 years compared with using hospital discharge data alone. The rates of hypertension, diabetes and lipid disorders increased in all age groups when outpatient data were added to hospital discharge data. The differences in the rates were more pronounced in women aged 50-79 years. However, the age-specific rates were higher in men except for hypertension which was higher in older women. CONCLUSION: Data for epidemiological analyses of diseases are often based on hospital discharge data. This study found that hospital discharge data provide limited information on patients treated for IHD and coronary risk factors, except for AMI. These findings suggest that hospital discharge data should be combined with outpatient care data to provide a more comprehensive estimate of the burden of IHD and its risk factors.
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| 40. |
- Fantahun, Mesganaw, et al.
(författare)
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Ageing of a rural Ethiopian population : who are the survivors?
- 2009
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Ingår i: Public health. - : Elsevier. - 1476-5616 .- 0033-3506.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study assessed trends in survival to old age and identified the factors associated with longevity among the elderly (age >/=65 years). STUDY DESIGN: Cohort analysis of demographic surveillance data. METHODS: The study was conducted in the Butajira Rural Health Programme Demographic Surveillance Site in Ethiopia. Using data collected between 1987 and 2004, the probability of survival to 65 years and remaining life expectancy for women and men aged 65 years were computed. Cox regression analysis was used to assess survival by different factors. RESULTS: Although the elderly represented 3% of the population, their person-time contribution increased by 48% over the 18-year period. Less than half reached 65 years of age, with remaining life expectancy at 65 years ranging from 15 years in rural men to 19 years in urban women. Rural residence, illiteracy and widowhood were associated with lower survival adjusted for other factors, whereas gender did not show a significant difference. However, the effect of these factors differed between men and women, as demonstrated by survival curves and Cox regression. Widowhood [hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.59-2.57] and illiteracy (HR 2.26, 95% CI 1.86-2.73) affected males to a greater extent than females, and rural residence was associated with poorer female survival (HR 1.68, 95% CI 1.55-1.83). CONCLUSIONS: The number of elderly people is increasing in Ethiopia, with the chance of survival into older age being similar between men and women and approaching that in developed countries. However, rural women and illiterate women and men, particularly widowers, are disadvantaged in terms of survival.
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| 41. |
- Fottrell, Edward, et al.
(författare)
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Identifying humanitarian crises in population surveillance field sites : simple procedures and ethical imperatives.
- 2009
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 123:2, s. 151-155
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Effective early warning systems of humanitarian crises may help to avert substantial increases in mortality and morbidity, and prevent major population movements. The Butajira Rural Health Programme (BRHP) in Ethiopia has maintained a programme of epidemiological surveillance since 1987. Inspection of the BRHP data revealed large peaks of mortality in 1998 and 1999, well in excess of the normally observed year-to-year variation. Further investigation and enquiry revealed that these peaks related to a measles epidemic, and a serious episode of drought and consequent food insecurity that went undetected by the BRHP. This paper applies international humanitarian crisis threshold definitions to the BRHP data in an attempt to identify suitable mortality thresholds that may be used for the prospective detection of humanitarian crises in population surveillance sites in developing countries. STUDY DESIGN: Empirical investigation using secondary analysis of longitudinal population-based cohort data. METHODS: The daily, weekly and monthly thresholds for crises in Butajira were applied to mortality data for the 5-year period incorporating the crisis periods of 1998-1999. Days, weeks and months in which mortality exceeded each threshold level were identified. Each threshold level was assessed in terms of prospectively identifying the true crisis periods in a timely manner whilst avoiding false alarms. RESULTS: The daily threshold definition is too sensitive to accurately detect impending or real crises in the population surveillance setting of the BRHP. However, the weekly threshold level is useful in identifying important increases in mortality in a timely manner without the excessive sensitivity of the daily threshold. The weekly threshold level detects the crisis periods approximately 2 weeks before the monthly threshold level. CONCLUSION: Mortality measures are highly specific indicators of the health status of populations, and simple procedures can be used to apply international crisis threshold definitions in population surveillance settings for the prospective detection of important changes in mortality rate. Standards for the timely use of surveillance data and ethical responsibilities of those responsible for the data should be made explicit to improve the public health functioning of current sentinel surveillance methodologies.
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| 42. |
- Gillander Gådin, Katja, et al.
(författare)
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Can school-related factors predict future health behaviour among young adolescents?
- 2002
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Ingår i: Public Health. - 0033-3506 .- 1476-5616. ; 116:1, s. 22-29
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Tidskriftsartikel (refereegranskat)abstract
- Although the prevention of unfavourable health behaviour among young people has high priority in public health, the possibility of finding risk factors at school has not been sufficiently studied. The objective of this study was to find predictors among young pupils for later unfavourable health behaviour, with special focus on school-related factors.A three-year prospective study was started in 1994 including 279 pupils (141 girls and 138 boys) from different socioeconomic areas. The pupils answered a comprehensive questionnaire in grade six and grade nine. The non-response rate was negligible. The best predictors for health behaviour among boys and girls in grade nine were factors related to earlier health/health behaviour. The results also indicated that school-related factors could predict future health behaviour, especially in relation to low physical activity among girls.The school has an important role to play in identification of future unfavourable health behaviour among pupils at the school, both directly through recognising school-related risk factors and also indirectly through paying special attention to pupils with unfavourable health/health behaviour. Our findings indicate the need for more research in younger ages, as negative health behaviour already seems to be established at 12 y of age.
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| 43. |
- Godoy-Ramirez, K., et al.
(författare)
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Exploring childhood immunization among undocumented migrants in Sweden - following qualitative study and the World Health Organizations Guide to Tailoring Immunization Programmes (TIP)
- 2019
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 171, s. 97-105
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: National vaccination coverage in Sweden is high. Recurrent outbreaks of measles and rubella however highlight some immunity gaps in the population. Current knowledge about immunization status of undocumented migrant children is scant. The World Health Organization/Europe has developed the Guide to Tailoring Immunization Programmes (TIP) to assist countries in diagnosing barriers and motivators to vaccination in communities with low vaccination coverage. Based on the TIP guide, the objective of this study was to explore determinants to vaccination among undocumented immigrants, using qualitative approach. Study design: The study consisted of three steps: (i) an initial workshop for problem statement; (ii) qualitative research for increased understanding of the vaccination practices of children in the undocumented community; and (iii) a second workshop to incorporate the qualitative interview findings together with data from key stakeholders into a conceptual framework. Methods: This was a qualitative study featuring interviews of seven undocumented parents recruited at non-governmental clinics, three nurses at Child Health Centers, and information from key stakeholders retrieved at workshops as part of the TIP process. Results: The content analysis revealed two main themes: parental fear of being questioned and parental acceptance of child immunization. Undocumented parents had a positive view and attitude toward childhood immunization but expressed strong fear of being asked for identification papers at healthcare facilities. Owing to lack of knowledge on entitlements of the undocumented among health personnel, parents were incorrectly rejected when seeking care for their children. Frequent mobility among undocumented may limit access to complete the immunization schedule. Undocumented parents mistrust healthcare providers and avoid health facilities, further delaying childrens' access to health care, including immunization services. Conclusions: The findings of this study confirm the complexity of barriers that undocumented parents face regarding childhood immunization. The TIP guide offers a valuable process for a deeper understanding of the determinants of immunization challenges among undocumented migrants. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.
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| 44. |
- Granström, Fredrik, et al.
(författare)
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Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health : results from structural equation modelling
- 2021
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 196, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling. Study design: Cross-sectional survey. Methods: Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25–75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH. Results: The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences. Conclusions: The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.
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| 45. |
- Grjibovski, A M, et al.
(författare)
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Large social disparities in spontaneous preterm birth rates in transitional Russia
- 2005
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Ingår i: Public Health. - London : Elsevier BV. - 0033-3506 .- 1476-5616. ; 119:2, s. 77-86
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study estimated the effect of maternal sociodemographic, obstetric and lifestyle factors on the risk of spontaneous preterm birth in a Russian town.METHODS: All women with singleton pregnancies registered at prenatal care centres in Severodvinsk in 1999 comprised the cohort for this study (n=1559). Analysis was based on spontaneous live singleton births at the maternity home (n=1103). Multivariable logistic regression was applied to quantify the effect of the studied factors on the risk of preterm birth. Differences in gestation duration were studied using multiple linear regression.RESULTS: In total, 5.6% of all spontaneous births were preterm. Increased risks of preterm delivery were found in women with lower levels of education and in students. Placental complications, stress and a history of fetal death in previous pregnancies were also associated with elevated risks for preterm delivery. Smoking, hypertension and multigravidity were associated with reduced length of pregnancy in metric form.CONCLUSION: In addition to medical risk factors, social factors are important determinants of preterm birth in transitional Russia. Large disparities in preterm birth rates may reflect the level of inequalities in transitional Russia. Social variations in pregnancy outcomes should be monitored.
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| 46. |
- Gånedahl, Hanna, et al.
(författare)
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Work-site wellness programmes in Sweden : a cross-sectional study of physical activity, self-efficacy, and health
- 2015
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 129:5, s. 525-530
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, a work-site wellness programme implies reimbursing some of the expenses for health-promoting activities. Although work-site wellness programmes are readily available in Sweden, a large number of employees elect not to participate.OBJECTIVES: The aim of this study was to investigate the association of physical activity, self-reported general health assessment and self-efficacy with participation in a work-site wellness programme.STUDY DESIGN: A cross-sectional study design was used.METHODS: An online questionnaire was distributed to employees of a manufacturing company with 2500 employees in southwest Sweden.RESULTS: Those who took advantage of the work-site wellness programme assessed their general health as better and had higher assessment of physical activity. The study showed that being enlisted also implies a higher level of physical activity and general health; however, the effect sizes of these correlations were small. Self-efficacy, i.e. perceived behavioural control, was not associated with participation in the work-site wellness programme. However, self-efficacy was correlated with both general health assessment and physical activity. A regression analysis to determine explanatory contributions to the general health assessment score showed no significant contribution from participation in a work-site wellness programme, but was instead explained by perceived behavioural control and physical activity.CONCLUSIONS: Given the small effect size of the difference in physical activity between participators and non-participators in the work-site wellness programme, it is probable that only a small proportion of participators changed their health-promoting activities as a result of the work-site wellness programme.
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| 47. |
- Hammarström, Anne, et al.
(författare)
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Gender-related explanatory models of depression : a critical evaluation of medical articles
- 2009
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 123:10, s. 689-693
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Although research has consistently shown a higher prevalence of depression among women compared with men, there is a lack of consensus regarding explanatory factors for these gender-related differences. The aim of this paper was to analyse the scientific quality of different gender-related explanatory models of depression in the medical database PubMed.Study design: Qualitative and quantitative analyses of PubMed articles.Methods: In a database search in PubMed for 2002, 82 articles on gender and depression were selected and analysed with qualitative and quantitative content analyses. In total, 10 explanatory factors and four explanatory models were found. The ISI Web of Science database was searched in order to obtain the citation number and journal impact factor for each article.Results: The most commonly used gender-related explanatory model for depression was the biomedical model (especially gonadal hormones), followed by the sociocultural and psychological models. Compared with the other models, the biomedical model scored highest on bibliometric measures but lowest on measures of multifactorial dimensions and differences within the group of men/women.Conclusion: The biomedical model for explaining gender-related aspects of depression had the highest quality when bibliometric methods were used. However, the sociocultural and psychological models had higher quality than the biomedical model when multifactoriality and intersectionality were analysed. There is a need for the development of new methods in order to evaluate the scientific quality of research.
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| 48. |
- Hammarström, Anne, et al.
(författare)
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Mechanisms for the social gradient in health : results from a 14-year follow-up of the northern swedish cohort
- 2011
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Ingår i: Public Health. - London : Academic P.. - 0033-3506 .- 1476-5616. ; 125:9, s. 567-576
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Although numerous studies have demonstrated a socio-economic gradient in health, there is still a lack of research about the mechanisms behind this gradient. The aim of this study was to analyse possible mechanisms from adolescence to adulthood to explain the socio-economic gradient in somatic symptoms among men and women in the Northern Swedish Cohort. Study design: A prospective cohort study was performed, in which all pupils (n = 1083) in the last year of compulsory school were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were mainly collected through repeated comprehensive self-administered questionnaires.Methods: The main dependent variable was a combination of socio-economic position and somatic health at 30 years of age. Multivariate multinomial and bivariate logistic regression analyses were undertaken.Results: After controlling for parental working-class position and health-related selection, the authors identified mechanisms from adolescence to adulthood for the socio-economic gradient in health that were related to social relations (poor relationship with father and unemployed friends among men, violence among women), labour market experiences (unemployment among men and women, physically heavy work among women), economic hardship (among women) and poor health behaviour.Conclusion: These analyses contribute to the development of epidemiological methods for analysing mechanisms for the socio-economic gradient in health. (C) 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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| 49. |
- Hang, Hoang Minh, et al.
(författare)
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Difficulties in getting treatment for injuries in rural Vietnam
- 2009
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 123:1, s. 58-65
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Knowledge about the health-seeking behaviour of injury patients is important for the improvement of community health services. The aims of this study were: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients. STUDY DESIGN: This study took place in Bavi District, northern Vietnam within a longitudinal community surveillance site (FilaBavi). All non-fatal unintentional injuries occurring in a sample of 24,776 people during 2000 were recorded. METHOD: The injury questionnaire included information on care-seeking behaviour, severity and consequences of injury. Both univariate and multivariate logistic regression models were used to find associations between sociodemographic factors and utilization of any health services, as well as for each type of health service used, compared with the group who did not use any health services. RESULT: Of 24,776 persons living in the study area, 1917 reported 2079 new non-fatal debilitating injuries during the four 3-month periods of observation. Health-seeking behaviour relating to the first 1917 injuries was analysed. Self-treatment was most common (51.7%), even in cases of severe injury. There was low usage of public health services (23.2%) among injury patients. Long distances, poor economic status and residence in difficult geographic areas such as highlands and mountains were barriers for seeking health services. A large proportion of household income was spent on treating injury patients. Poor people spent a greater proportion of their income on health care than the rich, and often used less qualified or untrained private providers. CONCLUSIONS: These results demonstrate the logistical and financial difficulties associated with the treatment of injuries in rural Vietnam. This suggests the need to make public health subsidies available more efficiently and equitably. Whilst this study looked at the situation specifically in the context of injury treatment, it is likely that similar patterns apply in other areas of health care.
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| 50. |
- Hang, Hoang Minh, et al.
(författare)
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Unintentional injuries over a 1-year period in a rural Vietnamese community : describing an iceberg.
- 2005
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Ingår i: Public Health. - : Elsevier BV. - 0033-3506 .- 1476-5616. ; 119:6, s. 466-473
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.
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