| 1. |
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| 2. |
- Bolin, Kristian, et al.
(författare)
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Investments in social capital - implications of social interactions for the production of health
- 2003
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Ingår i: Social Science and Medicine. - 1873-5347 .- 0277-9536. ; 56:12, s. 2379-2390
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Tidskriftsartikel (refereegranskat)abstract
- This paper develops a theoretical model of the family as producer of health- and social capital. There are both direct and indirect returns on the production and accumulation of health- and social capital. Direct returns (the consumption motives) result since health and social capital both enhance individual welfare per se. Indirect returns (the investment motives) result since health capital increases the amount of productive time, and social capital improves the efficiency of the production technology used for producing health capital. The main prediction of the theoretical model is that the amount of social capital is positively related to the level of health; individuals with high levels of social capital are healthier than individuals with lower levels of social capital, ceteris paribus. An empirical model is estimated, using a set of individual panel data from three different time periods in Sweden. We find that social capital is positively related to the level of health capital, which supports the theoretical model. Further, we find that the level of social capital (1) declines with age, (2) is lower for those married or cohabiting, and (3) is lower for men than for women. (C) 2003 Elsevier Science Ltd. All rights reserved.
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| 3. |
- Clarke, PM, et al.
(författare)
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On the measurement of relative and absolute income-related health inequality
- 2002
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Ingår i: Social Science and Medicine. - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 55:11, s. 1923-1928
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Tidskriftsartikel (refereegranskat)abstract
- In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a measure of health inequality. A drawback of this measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health inequality measure by comparing the income-related inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health inequality in different populations. (C) 2002 Elsevier Science Ltd. All rights reserved.
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| 4. |
- Dozet, Alexander, et al.
(författare)
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Health care for the elderly: two cases of technology diffusion.
- 2002
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Ingår i: Social Science and Medicine. - 1873-5347 .- 0277-9536. ; 54:1, s. 49-64
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Tidskriftsartikel (refereegranskat)abstract
- Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.
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| 5. |
- Lindström, Martin, et al.
(författare)
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Socioeconomic differences in leisure-time physical activity : The role of social participation and social capital in shaping health related behaviour
- 2001
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Ingår i: Social Science and Medicine. - 0277-9536. ; 52:3, s. 441-451
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have shown socioeconomic differences in leisure-time physical activity. One explanation may be socioeconomic differences in relevant psychosocial conditions. The Malmo Diet and Cancer Study is a prospective cohort study including inhabitants in Malmo, Sweden. The baseline questionnaire used in this cross-sectional study was completed by the 11,837 participants born 1926-1945 in 1992-1994. Leisure-time physical activity was measured by an item presenting a variety of activities. These activities were aggregated into a summary measure of leisure-time physical activity that takes both the intensity and duration of each specific activity into consideration. The effects of the psychosocial variables on the socioeconomic differences in leisure-time physical activity were calculated in a multivariate logistic regression analysis. The quartile with the lowest degree of leisure-time physical activity was not evenly distributed between the socioeconomic groups. Socioeconomic differences were seen as odds ratios 1.5 for skilled and 1.5 for unskilled male manual workers, compared to the high level non-manual employees. An OR 1.6 was observed for female unskilled manual workers. Self-employed men and female pensioners also had a significantly increased risk of low leisure-time physical activity. Adjustment for age, country of origin and previous/current diseases had no effect on these SES differences. Finally, adjusting for social participation almost completely erased the SES differences. Among the psychosocial variables, social participation was the strongest predictor of low physical activity, and a strong predictor for socioeconomic differences in low leisure-time physical activity. Social participation measures the individual's social activities in, for example political parties and organisations. It therefore seems possible that some of the socioeconomic differences in leisure-time physical activity are due to differing social capital between socioeconomic groups. (C) 2001 Elsevier Science Ltd.
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| 6. |
- Nettelbladt, Per, et al.
(författare)
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The social network of patients with schizoaffective disorder as compared to patients with diabetes and to healthy individuals
- 1995
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Ingår i: Social Science and Medicine. - 0277-9536. ; 41:6, s. 901-907
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Tidskriftsartikel (refereegranskat)abstract
- The social network was evaluated by means of the self-rating scale 'Interview Schedule for Social Interaction' (ISSI) and semi-structured interviews in married patients with a DSM-III diagnosis of schizoaffective disorder (N = 17, partners, N = 16), married patients with diabetes (N = 10, partners, N = 10) and in married healthy individuals (N = 8, partners, N = 8). The two latter groups were comparison control groups matched for sex and age to the patients with a schizoaffective disorder. The scores on the ISSI and its subscales for the groups were compatible to those found in other Swedish studies. Patients with a schizoaffective disorder both experienced that they had less access to (AVAT) and were less satisfied with their deep emotional relations (ADAT). The same patients had a higher level of neuroticism as compared to the rest. The patients with a schizoaffective disorder had less often than the patients with diabetes been informed about their disease. Moreover, the partners to the patients with a schizoaffective disorder had not been informed about the disease and experienced that they had fewer social contacts (AVSI). A challenge for the professional network in psychiatry is to improve the information and education to families in which one member is struck by a schizoaffective disorder.
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| 7. |
- Pudaric, Sonja, et al.
(författare)
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Country of birth, instrumental activities of daily living, self-rated health and mortality: a Swedish population-based survey of people aged 55-74.
- 2003
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Ingår i: Social Science and Medicine. - 1873-5347 .- 0277-9536. ; 56:12, s. 2493-2503
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Tidskriftsartikel (refereegranskat)abstract
- There is scant knowledge of the effects of country of birth on the health of individuals in the years prior to and after retirement. The aim of this study was to consider country of birth in relation to health status, instrumental activities of daily living (IADL) and all-cause mortality when adjusted for socioeconomic status (SES). Cross-sectional data were collected between 1986 and 1991 on 8959 individuals between the ages of 55 and 74. Self-reported data were analysed using a logistic regression model while the mortality data were analysed by means of a proportional hazard model. In the present study, immigrants from Southern Europe, Eastern Europe and Finland carried significantly increased risks of poor health even after adjustment for SES. Southern Europeans, refugees from Developing countries and Finns exhibited an increased risk of impaired IADL compared to Swedes, even after adjustment for SES. In conclusion, country of birth was associated with poor health status and impaired IADL. This association remained after adjustment for SES. In accordance with pre-study expectations, mortality was predicted by impaired IADL and male gender. Country of birth was not associated with all-cause mortality.
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| 8. |
- Sundquist, K, et al.
(författare)
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Social participation and coronary heart disease: a follow-up study of 6900 women and men in Sweden
- 2004
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Ingår i: Social Science and Medicine. - 1873-5347 .- 0277-9536. ; 58:3, s. 615-622
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have examined the relationship between social, cultural and religious participation, political empowerment and coronary heart disease (CHD). The aim of this study was to examine whether low social participation, as described in a social participation index, predicted incidence rates of CHD. This is a follow-up study, from 1990-91 to 31 December 2000, of 6861 Swedish women and men, who were interviewed about their social participation, education, housing tenure and smoking habits. A social participation index was constructed, based on 18 variables from the survey. The outcome measure was CHD morbidity and mortality. Respondents with a CHD incident from 1986 until interview were excluded from the study. Data were analysed using Cox' regression and the results are presented as hazard ratios (HR) with 95% confidence intervals (Q. In the sex- and age-adjusted model there was a gradient between the social participation index and CHD, so that persons with low social participation had the highest risk of CHD with HR = 2.15; CI = 1.57-2.94, followed by HR = 1.67; Cl = 1.23-2.27 for those with middle social participation. In the full model, when education, housing tenure and smoking habits were included, the increased risk of CHD for persons with low social participation remained high, with HR = 1.69, CI = 1.21-2.37. We conclude that persons with low social participation in the social participation index exhibited an increased risk of CHD that remained after adjustment for education, housing tenure and smoking habits. (C) 2003 Elsevier Science Ltd. All rights reserved.
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Andersen, Ronald, et al.
(författare)
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Cost containment, solidarity and cautious experimentation : Swedish dilemmas
- 2001
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 52, s. 1195-1204
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Tidskriftsartikel (refereegranskat)abstract
- This paper uses secondary data analysis and a literature review to explore a “Swedish Dilemma”: Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay — a policy emphasizing “solidarity” — or must it decide to impose increasing constraints on health services spending and service delivery — a policy emphasizing “cost containment?” It examines recent policies and longer term trends including: changes in health personnel and facilities; integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment — not primarily through “market mechanisms” but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Brenner, Sven-Olof, et al.
(författare)
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Long-term unemployment among women in Sweden
- 1987
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 25:2, s. 153-161
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Tidskriftsartikel (refereegranskat)abstract
- Vulnerability at long-term unemployment is discussed and the results of a study of the effects of job loss and long-term unemployment among Swedish women are presented. Psychological and physiological data for the unemployed were sampled repeatedly over a two year period. Some of the unemployed were subject to an intervention programme aiming at buffering for the possibly negative effects of unemployment. Health data from matched control groups of employed were gathered over the same period. The results indicate a strong negative stress reaction at the job loss period, followed by a gradual adaptation to the conditions of unemployment as measured by biochemical and physiological health indicators. However, a substantial proportion of the unemployed compared to the employed showed a lower degree of psychological well-being and more severe depressive reactions. Recommendations are given concerning further research approaches on long-term unemployment. Policy implications to reduce vulnerability at long-term unemployment are discussed
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| 17. |
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| 18. |
- Carlson, Per
(författare)
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Self-perceived health in east and west Europe. : Another European health divide
- 1998
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 46:10, s. 1355-1366
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Tidskriftsartikel (refereegranskat)abstract
- There is a great, and possibly also a growing, difference in public health between the central, eastern (CEE) and western European countries. Several suggestions have been put forward as explanations for this health divide. A broader framework than one focusing on medical care systems or behavioural patterns is necessary to examine this difference. It will be more fruitful to try to identify social and economic factors at large, as well as specific explanatory factors. The aim of this study is to find out to what extent "The East-West Mortality Divide" was apparent in people's perception of their own health in 1990-1991, as a division in self-perceived health across Europe. If there were indeed differences, the aim is to examine whether or not they can be explained by specific economic and social conditions present in the early 1990s. Data from "World Values Survey 1990" reveal a striking east west divide in self-perceived health among people in the age group 35-64 yr, one of greater size than the gender gap in self-perceived health. The importance of a number of circumstances for people's self-perceived health in the 25 European countries was estimated. The assumption was that any resulting difference between eastern and western European countries could help to explain the health divide. An attempt was made to estimate how much the east-west health divide would be reduced if some of these circumstances were similar in CEE to those in the west. The results indicate that people's participation in civic activities has a positive effect on their health. This effect is recognised especially on a societal level. This supports theories about civic activities and community performance. In western Europe the tradition of the active citizen is more developed than in eastern Europe. People's life control was important for their self-perceived health in almost every European country, both in the west and the east. In the former communist countries, however, people did not feel that they had the same control over their lives as did people in the west. People's economic satisfaction was the most powerful predictor of self-perceived health, both in the eastern and western parts of Europe. The average level of economic satisfaction in 1990 1991 was considerably lower in CEE. If people's influence and economic resources were the same in the former communist countries as in the west, the health divide, according to my estimations, would decrease by something between 10-30%.
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| 19. |
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| 20. |
- Dong, Hengjin, et al.
(författare)
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Drug policy in China : pharmaceutical distribution in rural areas.
- 1999
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 48:6, s. 777-786
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Tidskriftsartikel (refereegranskat)abstract
- In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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New estimates of the demand for health : Results based on a categorical health measure and Swedish micro data
- 1999
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Ingår i: Social science & medicine (1982). - : Elsevier. - 1873-5347 .- 0277-9536. ; 49:10, s. 1325-1332
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we estimate a 'Grossman' model of demand for health based on Swedish micro data. The data set consists of a random sample of over 5000 individuals taken from the Swedish adult population. Health capital is measured by a categorical measure of overall health status, and an ordered probit model is used to econometrically estimate the demand for health equation. The results are consistent with the theoretical predictions and show that the demand for health increases with income and education and decreases with age, male gender, overweight, living in big cities and being single.
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| 27. |
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| 28. |
- Gustafsson Stolt, Ulrica, 1965-, et al.
(författare)
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Attitudes to bioethical issues : a case study of a screening project
- 2002
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 54:9, s. 1333-1344
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Tidskriftsartikel (refereegranskat)abstract
- Commonly expressed in theoretical discussions about ethical problems in the context of epidemiology and screening is the need for more data. A study was carried out involving 21 explorative interviews with participant and nonparticipant mothers in a neonatal research screening project in progress in Sweden, ABIS (All Babies in Southeast Sweden). The respondents were asked, by way of open-ended questions, to give their opinions about certain ethical issues: informed consent; reasons for joining/declining; surrogate decision; the collection, analysis and storage of written and “live” material (biobanks); intervention etc.The ethical implications mentioned in the literature mostly concern the risk of creating distress and anxiety (anxiety and possible stigmatisation in respect of positive or false-positive results, worry about material collected and stored, distress caused by blood sampling procedures, etc.). Our results do not support the idea that the risks are substantial. The respondents rather indicate an attitude of benevolence—they are positive both to the current research on children, to the material they contribute (both written material and “biomaterial”), to possible results and intervention plans. On the other hand the participants expressed concern about the storage of material and the right to be informed of any screening/project results. Further studies in this field are needed and would be of help in theoretical discussion, the work of ethical committees and the designing of, for example, screening and research projects.
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| 29. |
- Hallqvist, Johan, 1950-, et al.
(författare)
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Can we disentangle life course processes of accumulation, critical period and social mobility? An analysis of disadvantaged socio-economic positions and myocardial infarction in the Stockholm Heart Epidemiology Program.
- 2004
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 58:8, s. 1555-62
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Tidskriftsartikel (refereegranskat)abstract
- The accumulation hypothesis would propose that the longer the duration of exposure to disadvantaged socio-economic position, the greater the risk of myocardial infarction. However there may be a danger of confounding between accumulation and possibly more complex combinations of critical periods of exposure and social mobility. The objective of this paper is to investigate the possibility of distinguishing between these alternatives. We used a population based case-control study (Stockholm Heart Epidemiology Programme) of all incident first events of myocardial infarction among men and women, living in the Stockholm region 1992-94. The analyses were restricted to men 53-70 years, 511 cases and 716 controls. From a full occupational history each subject was categorized as manual worker or non-manual at three stages of the life course, childhood (from parent's occupation), at the ages 25-29 and 51-55, resulting in 8 possible socio-economic trajectories. We found a graded response to the accumulation of disadvantaged socio-economic positions over the life course. However, we also found evidence for effects of critical periods and of social mobility. A conceptual analysis showed that there are, for theoretical reasons, only a limited number of trajectories available, too small to form distinct empirical categories of each hypothesis. The empirical task of disentangling the life course hypotheses of critical period, social mobility and accumulation is therefore comparable to the problem of separating age, period, and cohort effects. Accordingly, the interpretation must depend on prior knowledge of more specific causal mechanisms.
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| 30. |
- Hallqvist, Johan, 1950-, et al.
(författare)
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Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).
- 1998
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 46:11, s. 1405-15
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Tidskriftsartikel (refereegranskat)abstract
- The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.
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| 31. |
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| 32. |
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| 33. |
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Johannesson, Magnus
(författare)
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A note on the relationship between ex ante and expected willingness to pay for health care
- 1996
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Ingår i: Social science & medicine (1982). - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 42:3, s. 305-311
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Tidskriftsartikel (refereegranskat)abstract
- It has been argued that the willingness to pay for health care services in contingent valuation studies should be assessed ex ante from an insurance perspective. It may however be easier to assess the willingness to pay among a group of patients in need of a specific treatment. This willingness to pay measure can be used to estimate the expected willingness to pay. This paper investigates the relationship between ex ante and expected willingness to pay. It is shown that expected willingness to pay is a lower bound for ex ante willingness to pay for a treatment that restores the individual to full health for an individual that is risk averse with respect to income. For a treatment that does not restore an individual to full health the expected willingness to pay is not necessarily a lower bound for the ex ante willingness to pay if the marginal utility of income increases with better health.
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| 38. |
- Johannesson, Magnus
(författare)
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QALYs, HYEs and individual preferences— A graphical illustration
- 1994
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Ingår i: Social science & medicine (1982). - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 39:12, s. 1623-1632
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Tidskriftsartikel (refereegranskat)abstract
- The choice of outcome measure in cost-utility analysis has been a matter of concern. In particular the theoretical properties of quality-adjusted life-years (QALYs) and healthy-years equivalents (HYEs) have been debated. In this paper the underlying preference assumptions of QALYs and HYEs are illustrated graphically. For QALYs the assumptions of mutual utility independence, constant proportional trade-off, and risk neutrality are explained and illustrated. Mutual utility independence is shown to guarantee that the quality weight with the standard gamble method is independent of the number of years in the health state and constant proportional trade-off is shown to guarantee that the quality weight with the time-trade-off method is independent of the number of years in the health state. Together these two assumptions leads to a utility function over life-years that exhibits constant proportional risk posture, which is the basis for the risk-adjusted QALY model. The more commonly used risk-neutral QALY model is shown to be a valid cardinal utility function if risk neutrality over life-years holds for all health states. For HYEs to be a valid cardinal utility function the somewhat less restrictive assumption of risk neutrality over life-years in full health has to be made. It is also shown graphically that the proposed two-stage procedure to measure HYEs in theory gives the same result as directly using the time-trade-off method. Finally, it is shown that by estimating the certainty-equivalent number of HYEs it is possible in theory to obtain a measure that will always rank risky health profiles according to individual preferences. It is concluded that further empirical work should be undertaken to test the ranking properties of the different measures.
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| 39. |
- Johannesson, Magnus
(författare)
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The relationship between cost-effectiveness analysis and cost-benefit analysis
- 1995
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Ingår i: Social science & medicine (1982). - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 41:4, s. 483-489
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Tidskriftsartikel (refereegranskat)abstract
- This paper examines the relationship between cost-effectiveness analysis and cost-benefit analysis. Provided that a cost-effectiveness analysis includes all the relevant societal costs, it is shown that a cost-effectiveness analysis can be interpreted as a cost-benefit analysis where the willingness to pay per effectiveness unit is assumed to be constant and the same for everyone. To relax this assumption the willingness to pay per effectiveness unit can be allowed to vary depending on for instance the size of the health effects and the target population. It is argued that cost-effectiveness analysis is best viewed as a subset of cost-benefit analysis, where the aim of the analysis is to estimate the cost function of producing health effects. It is also concluded that to interpret and use cost-effectiveness analysis as a tool to maximize the health effects for one specified real-world budget, will be inconsistent with a societal perspective and is likely to lead to major problems of suboptimization.
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| 40. |
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| 41. |
- Johansson, Gun, et al.
(författare)
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Adjustment latitude and attendance requirements as determinants of sickness absence or attendance : Empirical tests of the illness flexibility model
- 2004
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Ingår i: Social Science & Medicine. - 0277-9536. ; 58:10, s. 1857-1868
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates whether the two dimensions of illness flexibility at work, adjustment latitude and attendance requirements are associated to sickness absence and sickness attendance. Adjustment latitude describes the opportunities people have to reduce or in other ways change their work-effort when ill. Such opportunities can be to choose among work tasks or work at a slower pace. Attendance requirements describe negative consequences of being away from work that can affect either the subject, work mates or a third party. In a cross-sectional design data based on self-reports from a questionnaire from 4924 inhabitants in the county of Stockholm were analysed. The results showed that low adjustment latitude, as predicted, increased women's sickness absence. However, it did not show any relation to men's sickness absence and men's and women's sickness attendance. Attendance requirements were strongly associated to both men's and women's sickness absence and sickness attendance in the predicted way. Those more often required to attend were less likely to be absent and more likely to attend work at illness. As this is the first study of how illness flexibility at work affects behaviour at illness, it was concluded that more studies are needed.
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| 42. |
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| 43. |
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| 44. |
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| 45. |
- Karlsson, Göran, et al.
(författare)
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Cost-effectiveness analysis and capital costs
- 1998
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Ingår i: Social science & medicine (1982). - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 46:9, s. 1183-1191
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Tidskriftsartikel (refereegranskat)abstract
- Traditionally, economic evaluations in terms of cost-effectiveness analysis are based, explicitly or implicitly, on the assumption of constant returns to scale. This assumption has been criticized in the literature and the role of cost-effectiveness as a tool for decision making has been questioned. In this paper we analyze the case of increasing returns to scale due to fixed capital costs. Cost-effectiveness analysis is regarded as a tool for estimating a cost function. To this cost function two types of decision rules can be applied, the budget approach and the constant price approach. It is shown that in the presence of fixed capital costs the application of these two decision rules to a specific patient group will give different results. The budget approach may lead to suboptimizations, while using the price as a decision rule will give optimal solutions. With fixed capital costs and when an investment can be used for treating several patient groups, these groups are no longer independent. Therefore the cost-effectiveness analysis has to be performed simultaneously for all patient groups that are potential users of the investment.
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| 46. |
- Kero, Anneli, 1950-, et al.
(författare)
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Legal abortion : a painful necessity
- 2001
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 53:11, s. 1481-1490
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Tidskriftsartikel (refereegranskat)abstract
- This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion.
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| 47. |
- Knutsson, Anders, et al.
(författare)
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Occupation and unemployment rates as predictors of long term sickness absence in two Swedish counties.
- 1998
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 47:1, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- The study was aimed to describe the prevalence of long term sickness absence in common male and female occupations and to determine the relative importance of unemployment rates for sickness absence. The prevalence of long term sick leave was investigated among 12 male and female occupations (N = 84,319) in two counties of Sweden. The age-adjusted sickness absence rate ranged between 0.5 and 9.5% among women and between 1.2 and 9.1% in men. When controlling for age and occupation there was no relationship between unemployment rates and sickness absence rate among females. Among males, however, an inverse relationship between unemployment rates and long term sickness absence was found. An unemployment rate of 6.1% or higher was associated with a relative risk for sickness absence of 0.4 compared with reference level 1.0 in the group with the lowest unemployment rate (0-1.1%). There was a strong positive correlation between age and absenteeism. Musculoskeletal symptoms was the dominating diagnostic group in all age groups Knutsson A, Goine H. Department of Occupational and Environmental Medicine, Umea University, Sweden. The study was aimed to describe the prevalence of long term sickness absence in common male and female occupations and to determine the relative importance of unemployment rates for sickness absence. The prevalence of long term sick leave was investigated among 12 male and female occupations (N = 84,319) in two counties of Sweden. The age-adjusted sickness absence rate ranged between 0.5 and 9.5% among women and between 1.2 and 9.1% in men. When controlling for age and occupation there was no relationship between unemployment rates and sickness absence rate among females. Among males, however, an inverse relationship between unemployment rates and long term sickness absence was found. An unemployment rate of 6.1% or higher was associated with a relative risk for sickness absence of 0.4 compared with reference level 1.0 in the group with the lowest unemployment rate (0-1.1%). There was a strong positive correlation between age and absenteeism. Musculoskeletal symptoms was the dominating diagnostic group in all age groups. PMID: 9683376 [PubMed - indexed for MEDLINE]
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| 48. |
- Kristenson, Margareta, 1950-, et al.
(författare)
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Psychobiological mechanisms of socioeconomic differences in health
- 2004
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 58:8, s. 1511-1522
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Tidskriftsartikel (refereegranskat)abstract
- The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.
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| 49. |
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