| 1. |
- Abbasi, Seyed
(författare)
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Determinants of social inequalities in cardiovascular disease among Iranian patients
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives: Cardiovascular disease (CVD) is the single largest cause of mortality in the world. Similar to other health issues, CVD is generally affected either by individual risk factors, which may influence the risk for developing an illness or its complications, or by social indicators (social determinants of health). There is evidence from developed countries which shows that the so-called "upstream factors"—including social determinants such as political, social, spiritual, cultural, and economic factors—may affect the prevalence and incidence of CVD. Scarce evidence from studies in low- and middle-income countries also suggests that social factors may affect the distribution of CVD across population groups. However, there is a dearth of such data in Iran, where only a few small-sizedstudies have focused on the social determinants of health. Therefore, the present thesis sought to fill this gap by assessing the effects of socioeconomic status (SES) on the distribution of CVD and the relevant inequalities within the Iranian context.Methods: This thesis is based on four studies, which used data from the Tehran Heart Center’s Databases. In Study I, a total of 44,820 patients who underwent coronary angiography at Tehran Heart Center between 2005 and 2010 were recruited. Then, their pre- and post-procedural data—including demographics, CVD risk factors, symptoms, and laboratory tests—were compared between men and women. In Study II, 6,246 patients with acutecoronary syndrome who were hospitalized between March 2004 and August 2011 were included and, based on their education and their employment status, were divided into high- and low-SES groups. Thereafter, the effect of SES on the in-hospital death of the patients was evaluated. In Study III, 20,165 patients with documented coronary artery disease who underwent coronary angiography at Tehran Heart Center were enrolled and CVD risk factors and severity (measured by the Gensini score) were assessed among the six major Iranian ethnic groups. In Study IV, 9,088 patients with acute coronary syndrome who were hospitalized at Tehran Heart Center between May 2007and June 2014 were recruited and the association between in-hospital death due to acute coronary syndrome and place of residence (rural/urban) was assessed using logistic regression adjusted for potential confounders.Results: In this thesis, the data analyses were based on the hypothesis that there is a potential association between the different socioeconomic indicators and the selected cardiovascular outcomes. In Study I, among the recruited participant, 25,363 men and 11,995 women had coronary artery disease and the women not only were significantly older, less educated, and more overweight but also had higher blood levels of triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and fasting blood sugar than the men. Moreover, hypertension and diabetes mellitus showed the strongest association in the women with coronary artery disease (OR=3.45, 95% CI: 3.28to 3.61 and OR=2.37, 95% CI: 2.26 to 2.48, respectively). In addition, the frequency of post-procedural recommendations for non-invasive procedures was higher in the women than in the men (20.1% vs 18.6%; P<0.001). In StudyII, of the 6,246 recruited patients with acute coronary syndrome, 3,290individuals were considered low-SES and 2,956 high-SES individuals. In-hospital death occurred in 79 (1.26%) patients: 1.9% in the low-SES and 0.6% in the high-SES groups. After adjustment for the possible cofounders, our multivariate analysis demonstrated a significant effect of the patients’ SES on their in-hospital death and a lower in-hospital mortality rate was shown in the high-SES patients (OR=0.30, 95% CI: 0.09 to 0.98; P=0.046). In Study III, the Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest frequency of having at least four simultaneous risk factors. Additionally, the mean Gensini score was lowest in the Lurs (67.5±52.8) and highest among the Gilaks (77.1±55.9). The multivariable regression analysis indicated that the Gilaks showed the worst CVD severity (β: 0.056, 95% CI: 0.009 to 0.102; P=0.018), followed by the Turks (β: 0.032, 95% CI: 0.005 to 0.059; P=0.020), and the lowest CVD severity, was detected in the Lurs (β: -0.087, 95% CI: -0.146 to -0.027;P=0.004). Study IV showed that while smoking (P=0.002), positive family history of coronary artery disease (P=0.003), higher body mass index (P=0.013),and hyperlipidemia (P=0.026) were more prevalent in the urban patients, the rural patients showed lower educational levels (P<0.001) and higher frequency of unemployment (P=0.009). Meanwhile, in-hospital death occurred in 135 (1.5%) patients: 125 (1.5%) urban and 10 (1.2%) rural. To adjust the effects of the possible confounders, we utilized the Firth regression model, which showed no significant difference regarding in-hospital death betweenthe rural and urban patients (OR=1.57, 95% CI: 0.376 to 7.450; P=0.585).Conclusions: The aim of this thesis was to investigate the effects of social determinants (particularly SES) on CVD and its modifiable risk factors among Iranian patients. Results showed that medical treatment for CVD was more recommended (by treating physicians) to the women than the men, and the low-SES patients with acute coronary syndrome were more likely to die in the hospital than their high-SES counterparts. In addition, the thesis found heterogeneity in the distribution of the traditional risk factors for CVD as well as CVD severity in the major Iranian ethnic groups. Further, there were no differences concerning the in-hospital death rates due to acute coronary syndrome between the urban and rural patients after adjustment for the potential confounders.
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| 2. |
- Abbasi, Seyed H, et al.
(författare)
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Ethnic differences in the risk factors and severity of coronary artery disease : a patient-based study in Iran
- 2018
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Ingår i: Journal of Racial and Ethnic Health Disparities. - : Springer Berlin/Heidelberg. - 2197-3792 .- 2196-8837. ; 5:3, s. 623-631
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Tidskriftsartikel (refereegranskat)abstract
- Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.
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| 3. |
- Abbasi, Seyed H, et al.
(författare)
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Gender Differences in the Risk of Coronary Artery Disease in Iran
- 2012
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Ingår i: Iranian Journal of Public Health. - 0304-4556. ; 41:3, s. 36-47
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Tidskriftsartikel (refereegranskat)abstract
- Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.
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| 4. |
- Abbasi, Seyed Hesameddin, et al.
(författare)
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Mortality from Acute Coronary Syndrome: Does Place of Residence Matter?
- 2022
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Ingår i: Journal of Teheran University Heart Center. - : Tehran University of Medical Sciences. - 1735-8620 .- 2008-2371. ; 17:2, s. 56-61
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment.Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders.Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585).Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS.
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| 5. |
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| 6. |
- Abbasi, Seyed, et al.
(författare)
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Socioeconomic status and in hospital mortality of acute corony syndrome: Can education and occupation serves as preventive measures?
- 2015
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Ingår i: International Journal of Preventive Medicine. - : Medknow. - 2008-7802 .- 2008-8213. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.
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| 7. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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A qualitative study of factors that managers in small companies consider important for their wellbeing
- 2023
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- PurposeGiven the importance of small businesses for society, and the significance of managers’ wellbeing for employee health, leadership, and business performance, more knowledge is needed on the sources of managers’ wellbeing. This study explored factors within the small business context that were perceived by managers to hinder or enable their wellbeing.MethodsData were collected through qualitative semi-structured interviews with 20 managers from 12 small companies, and analysed with content analysis.ResultsThe factors that these managers in small businesses experienced as enhancing or hindering their personal wellbeing covered five categories: demands and resources in the daily managerial work, achievement of results, social factors, organizational factors, and individual factors.ConclusionsThe specific context of managerial work in small companies encompasses unique factors. For instance, the small company managers’ wellbeing was affected by vulnerability due to the smallness of the business and the absence of available resources. Simultaneously, a small company context provided a strong social climate and close relationships with employees and customers that strengthened the managers’ wellbeing. The findings suggest that the availability of financial, personnel, and organizational resources varies between small companies of different size, which may have implications for small business managers’ work and wellbeing.
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| 8. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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FRAMFÖR (Framgångsrika företag i Gästrikland) : ett longitudinellt projekt om ledarskap, arbetsmiljö och effektivitet – fördel för både forskning, utbildning och ett hållbart arbetsliv?
- 2016
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Ingår i: Inkluderande och hållbart arbetsliv. - Östersund : Mittuniversitetet. ; , s. 48-48
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Konferensbidrag (refereegranskat)abstract
- Projektbeskrivning: FRAMFÖR har under 15 år bedrivits i Gästrikland i samarbete mellan utbildning och forskning vid Högskolan i Gävle, företagsutvecklare vid kommuner, företag och näringslivsorganisationer. Varje år delas utmärkelsen FRAMFÖR ut till 50 företag. Ambitionen är att uppmuntra framgångsrika företagare och visa upp intressanta exempel på hur framgång kan skapas. Processen startar med att 120 företag (>4 anställda) nomineras utifrån finansiella kriterier (ex. omsättningstillväxt, vinstmarginal). Sedan genomför studenter vid Ekonomprogrammet intervjuer med cheferna för dessa företag. Intervjuerna sker utifrån ett standardiserat frågeformulär kring arbetsmiljö, ledarskap, organisering och effektivitet. Avslutningsvis väljer en jury ut de 50 mest framgångsrika företagen utifrån såväl finansiella kriterier som studenternas intervjuresultat. Projektets trippel helixuppbyggnad (Utbildning, Forskning och, Företag) skapar nyttor för olika intressenter.Utbildningsnyttor: Studenterna får möjlighet till interaktion med företagare i sin direkta närhet. Aktiviteterna underlättar att uppfylla utbildningsmål där flera mål kan uppfyllas med samma aktiviteter. Förståelse för näringslivets förutsättningar samt kunskaper om ett vetenskapligt angreppssätt ökar.Forskningsnyttor: Stärker pågående forskning om hälsofrämjande och effektivt ledarskap inom arbetshälsovetenskap samt företagsutveckling inom företagsekonomi. Det stora urvalet av företag ger en bra bild av företagen i regionen och en möjlighet att följa dem över tid. Ambitionen är att få mer kunskap om hållbara och effektiva företag. Fördjupade studier av utmärkelseföretag möjliggörs och ett doktorandprojekt med inriktning på ledarskapsbeteenden, organisationsfaktorer, tidsanvändning samt chefers/medarbetares arbetsmiljö/hälsa i utmärkelseföretag är uppstartat.Företagsnyttor: Företagare får möta studenter och förstå hur de tänker. Ställda frågor, t.ex. rörande arbetsmiljö och ledarskap, kan starta reflektionsprocesser som bidrar till fortsatt utveckling. FRAMFÖR-utmärkelsen delas ut vid en högtidlig tillställning där företagarna kan bygga nätverk. Flera företagare lyfter fram det positiva symbolvärdet av att få utmärkelsen.Projektets framtid: Målet är att fortsätta ytterligare 15 år och fortsätta utveckla nyttorna för samtliga intressenter. Ett prioriterat område är återkoppling till företag i någon form samt ökad samverkan mellan studenter och företagare.
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| 9. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers’ and employees’ experiences of how managers’ wellbeing impacts their leadership behaviours in Swedish small businesses
- 2023
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Ingår i: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 75:1, s. 97-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:There is a growing interest in managers’ wellbeing due to the observed associations between their wellbeing and leadership behaviours, and between leadership behaviours and employees’ wellbeing. However, it is still unclear how managers’ wellbeing influences their practiced leadership across different workplace contexts, which specific behaviours are affected, and how this varies across time.OBJECTIVE:The purpose of this study was therefore to explore managers’ and employees’ experiences and perceptions regarding the consequences of managers’ wellbeing for their leadership behaviours in small businesses.METHODS:Semi-structured interviews were conducted with 37 participants (19 managers and 18 employees) working at 12 Swedish small firms, and analysed using content analysis.RESULTS:The findings show that managers were more constructive when they felt well, and more passively destructive when unwell. Variations in managers’ wellbeing influenced their mood, energy level, and performance, as well as the company’s working climate. However, these destructive leadership variations did not have a substantial impact, because several protective factors were present.CONCLUSION:This study shows that the wellbeing of managers in small businesses has perceptible consequences for their leadership behaviours. The study also shows that sustained leadership behaviours may coexist with temporary variations of these behaviours on a constructive-destructive continuum depending on the leader’s wellbeing. Overall, the findings contribute to a more nuanced and dynamic understanding of how the interaction between managers’ wellbeing and their behaviours unfolds in the particular context of small companies.
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| 10. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers in the context of small business growth: a qualitative study of working conditions and wellbeing
- 2024
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Ingår i: BMC Public Health. - : Springer. - 1471-2458. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- PurposeIn view of the importance of managers’ wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers’ wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers’ wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth.MethodsThe study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied.ResultsThe findings indicate that a manager’s working environment evolves from its initial stages and through the company’s growth, leading to variations over time in the manager’s experiences of wellbeing and work–life balance as well as changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work–life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers’ increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers’ wellbeing.ConclusionsThis study shows that, in the context of small business, managers’ working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers’ working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.
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| 11. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers’ work and behaviour patterns in profitable growth SMEs
- 2021
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Ingår i: Small Business Economics. - : Springer. - 0921-898X .- 1573-0913. ; 57, s. 849-863
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Tidskriftsartikel (refereegranskat)abstract
- We investigated managers’ work and behaviour patterns in profitable growth small- and medium-sized Swedish companies, and considered how these patterns might be associated with good health outcomes. Specifically, we looked at hours worked by managers, proportion of time spent on working activities, and leadership behaviour orientation. We used a quantitative cross-sectional design and collected data via a standardized questionnaire that was answered by 133 top managers. The data were analyzed with descriptive statistics, linear regression, and compositional data analysis. Our results indicate that the managers worked long hours, which is a health risk both for them as individuals and for their organizations, but also that they engaged in work practices and leadership behaviours that were favourable for organizational health and for their employees. The managers spent a high proportion of their time in touring, which could be beneficial to organizational health, and exercised active leadership through behaviours that contribute to both employee health and company effectiveness. Comparing our results to other studies, we can observe that patterns of managers’ time use differ between small and large companies, confirming that the size of the firm is an important determinant of managerial work.
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| 12. |
- Ahmadi, Elena, 1978-
(författare)
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Managers’ Work, Working Conditions and Wellbeing in Small Companies with Profitable Growth
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Managers’ work, working conditions and wellbeing are important determinants of occupational health in organizations. Nevertheless, little research has investigated these factors in the context of small growing businesses, which are known to contribute to employment, economic growth and social stability. The aim of this thesis was to explore managers’ work, working conditions and wellbeing in the context of small businesses with profitable growth. Methods Study I used a cross-sectional design to assess patterns in managerial work activities and leadership behaviours. Studies II–IV used qualitative interviews with managers (II–IV) and employees (II) to explore the effects of managers’ wellbeing on their leadership (II), their working conditions (III), and changes in their working conditions and wellbeing in the context of growing small businesses (IV).Results Managers worked long hours, posing risks for occupational health, but also adopted work practices that bolster occupational health. Firm size matters for managerial work. Managers’ wellbeing reflected in their mood and energy levels and influenced their leadership behaviours and performance, and the company’s work environment. Managers were more constructive when they felt well, and more passively destructive when they felt unwell. Certain factors mitigated the consequences of their negative behaviours in the organization. Five types of managers’ demands and resources (daily managerial work; achievement of results; and social; organizational; and individual factors) were identified, where the specificity of the small business context revealed unique characteristics. Company growth changed managers’ experiences of working conditions and wellbeing.Conclusions The specific context of small growing businesses shaped managers’ work, working conditions and wellbeing and the interplay between them. Dynamism in the organizational context due to growth had implications for managers’ work, working conditions and wellbeing.
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| 13. |
- Ahmadi, Elena, 1978-, et al.
(författare)
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Managers’ working hours and time allocation in effective SMEs – an organizational health perspective
- 2018
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Ingår i: FALF KONFERENS 2018 Arbetet – problem eller potential för en hållbar livsmiljö? 10-12 juni 2018 Gävle. - Gävle : Gävle University Press. - 9789188145284 ; , s. 118-
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Konferensbidrag (refereegranskat)abstract
- BackgroundThere is an increased global interest in occupational health across small businesses as they represent a large share of employers in many societies. In the model of healthy work organisations, employee health is a prerequisite for higher productivity and profitability and management practices are considered as determinants of organisational health. A better understanding of how managers in effective companies use their time can offer a better understanding of how this can affect employees’ well-being and business effect-iveness. Managers’ long working hours and share of time spent on Management by Walking Around (MBWA) are considered important characteristics of managers’ work that might have consequences for employees’ and managers’ own health outcomes, as well as for organisational effectiveness. MBWA is a management technique common for successful companies in regard to their effectiveness; providing an opportunity for a spontaneous manager-subordinate interaction that might be important for employee health and wellbeing. Studies of managerial work have to some extent not clearly placed managers’ time use in the broad context of leadership, often missing to link it with leadership behaviour theories, health and effectiveness.ObjectiveThe objective of this study was to explore, on the one hand, the total amount of working hours that managers spent, and on the other, their patterns of time allocation to different activities in effective SMEs. Research questions were: 1) What patterns regarding managers’ working hours can be identified across socio-demographic variables, leader-ship experience factors and leadership profiles in effective SMEs? 2) What patterns regarding proportions of total working hours spent on MBWA can be identified across socio-demographic variables, leadership experience factors and leadership profiles in effective SMEs?MethodThe study used data collected within the project, “Successful Companies in Gästrikland”. Annually the project nominates 120 companies for the award based on companies’ financial indicators. The study employed a cross-sectional design and analysed responses to questionnaires collected within the project during years 2014-2018. The inclusion criteria were small and medium sized companies (more than four and less than 250 subordinates), high-level managers having subordinates. Data analysis were carried out using descriptive statistics and regression analysis.ResultsThe results section is being processed and will be reported on the conference.
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| 14. |
- Antai, Diddy, et al.
(författare)
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Inequities in Under-Five Mortality in Nigeria : Differentials by Religious Affiliation of the Mother
- 2009
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Ingår i: Journal of religion and health. - : Springer Science and Business Media LLC. - 0022-4197 .- 1573-6571. ; 48:3, s. 290-304
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Tidskriftsartikel (refereegranskat)abstract
- Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.
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| 15. |
- Antai, D, et al.
(författare)
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Inequities in under-five mortality in Nigeria : differentials by ethnic affiliation of the mother
- 2009
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Ingår i: Journal of religion and health. - 0022-4197 .- 1573-6571. ; 48:3, s. 290-304
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Tidskriftsartikel (refereegranskat)abstract
- Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.
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| 16. |
- Aspelin, Johanna, et al.
(författare)
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Gender differences in self-reported health during times of economic crises: Does employment status matter?.
- 2015
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Ingår i: International Journal of Health Sciences & Research. - 2249-9571. ; 5:2, s. 246-257
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Tidskriftsartikel (refereegranskat)abstract
- Background: Employment status has an impact on health and is a source of health inequalities. But little is known about its impact on the health of people residing in the County of Västernorrland, Sweden. The recent economic recession affected this region in a way which worsened the already existing unemployment rate.Objective of the study: This study aimed to examine the relationship between employment status, gender and self-reported health in the County of Västernorrland, Sweden in the year 2010.Setting and Design: The study used data from a cross-sectional "Health on Equal Terms" survey, carried in the County of Västernorrland in 2010. A total of 6,050 women and men aged 16-65 years were included in the analysis. Descriptive statistics and logistic regression analyses were performed, and results were expressed as odds ratio with 95% confidence intervals.Results: Women and men who were out of work had odds of poor self-reported health of 2.31 (CI 1.94-2.94) and 2.39 (CI 1.96-2.58), respectively. Controlling for other variables reduced the odds of poor health, but the relationship continued to be statistically significant.Conclusion: Results of this study found that at the pick of the most recent economic crises there were equal odds of poor self-reported health among women and men residing in Gävleborg County. The observed association was to some extent explained by demographic, socioeconomic and health-related variables. Policymakers need to pay attention to the health status of those out of work, particularly during times of economic recession and hardship.
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| 17. |
- Awuba, Jude, et al.
(författare)
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HIV/AIDS in Cameroon : Rising gender issues in policy-making matters
- 2007
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Ingår i: African Journal of Health Sciences. - : African Journals Online (AJOL). - 1022-9272 .- 2306-1987. ; 14:3-4, s. 118-128
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Tidskriftsartikel (refereegranskat)abstract
- This literature review investigated gender differentials in HIV/AIDS in Cameroon and to which extent gender was taken into account in the country’s current policy on HIV/AIDS. The review found that in Cameroon women were at increased risk of being infected with HIV/AIDS compared to men and that apart from biological vulnerability, socio-cultural as well as economic factors accounted for those differences. In addition, the review found that at the policy level, the government has drawn up plans to reduce the high prevalence of HIV/AIDS among women. However, although the current policy acknowledged the need for tackling gender differentials in HIV/AIDS transmission; little has been done at the level of implementation. The current policy needs to be implemented in a more effective manner and a multisectorial approach should be explored in order to curb the current trend of the feminization of HIV/AIDS in Cameroon.
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| 18. |
- Begum, Afroza, et al.
(författare)
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Parental socio-economic position and suicidal ideation among adolescents in Rural Bangladesh
- 2018
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Ingår i: Journal of Psychiatry and Behavioral Sciences. - : MedDocs Publishers LLC. - 2637-8027. ; :4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Suicide is a leading cause of death worldwide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem. Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20. Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation. Conclusion: Parental socio-economic position was associated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.
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| 19. |
- Begum, Afroza, et al.
(författare)
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Prevalence of suicide ideation among adolescents and young adults in Bangladesh
- 2017
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Ingår i: International Journal of Mental Health. - : Informa UK Limited. - 0020-7411 .- 1557-9328. ; 46:3, s. 177-187
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Tidskriftsartikel (refereegranskat)abstract
- Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.
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| 20. |
- Begum, Afroza
(författare)
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Social Determinants of Suicidal Ideation among Adolescents in Rural Bangladesh
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and Objective: Suicide is a leading cause of death and a critical public health problem among adolescents worldwide. However, adolescent suicidal behaviour is a neglected public health issue, especially in low- and middle-income countries, such as Bangladesh. There is evidence from developed countries showing that suicidal ideation (SI) among adolescents is related to social indicators as well as individual risk factors. Scarce evidence from studies inlow- and middle-income countries suggests that social factors may influence adolescent SI. In Bangladesh, only a few studies have focused on the social determinants of suicide, and the present study is the first to examine the prevalence and social determinants of suicidal ideation among adolescents in rural Bangladesh. Therefore, the present thesis assessed the effects of socioeconomic status (SES) on adolescent SI.Methods: The present thesis is based on two studies, which used data from a cross-sectional survey conducted in 2013 among 2,476 adolescents aged 14-19 years selected randomly in arural community in Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, an area surveyed within the Injury Prevention Program of the Centre for Injury Prevention and Research, Bangladesh (CIPRB). Study I estimated the prevalence of suicidal ideation among adolescents and investigated what factors were associated with suicidal ideation. Study II examined the relationship between parental socio-economic factors and suicidal thoughts among adolescents.Results: Study I showed that life time prevalence of suicidal ideation was 5% among adolescents. The majority of adolescents with suicidal ideation were female (67, 5.3%), unmarried (106, 5.5%) and students (86, 6.2%). Suicidal ideation was significantly associated with age, education, occupation and living with parents or others. Respondents aged 18-19 years, had a Secondary school certificate (SSC) and Higher Secondary school certificate (HSC) or higher, were day labourers, living without parent had odds ratios of 2.31 (CI 1.46-3.65), 2.38(CI 1.51-3.77), 4.15 (CI 2.41-7.14), .28 (CI 0.13-0.60) and 1.80 (CI 1.07-3.03), respectively.In study 2, results demonstrated that suicidal ideation was more common among adolescents with parents from the low-income group (5.5%). In addition, adolescent SI was found to be significantly associated with parental education, marital status and house ownership. Adolescents whose parents received an SSC or higher had an SI odds ratio of 2.10 (CI 1.21-3.64) and 1.92 (CI 1.15-3.23) for mothers and fathers respectively. Suicidal ideation among adolescents with single parents was higher with an odds ratio of 3.00 (CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house had an odds ratio of 0.14 (0.05, 0.35).Conclusion: The thesis found that the prevalence of lifetime suicidal ideation among adolescents is moderately high in a rural community of Bangladesh. Furthermore, it was observed that personal characteristics such as parental marital status, education and homeownership were statistically significantly associated with suicidal ideation among adolescentseven after adjusting for potential confounders.
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| 21. |
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| 22. |
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| 23. |
- Burström, Bo, et al.
(författare)
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Equitable child health interventions : the impact of improved water and sanitation oninequalities in child mortality in Stockholm at the turn of the 19th century
- 2005
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Ingår i: American Journal of Public Health. - 0090-0036 .- 1541-0048. ; 95:2, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- Today, many of the 10 million childhood deaths each year are caused by diseases of poverty—diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality.In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.
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| 24. |
- Burström, Bo, et al.
(författare)
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Equitable child health interventions : the impact of improved water and sanitation on inequalities in child mortality in Stockholm, 1878 to 1925.
- 2005
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Ingår i: American Journal of Public Health. - 0090-0036 .- 1541-0048. ; 95:2, s. 208-216
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Tidskriftsartikel (refereegranskat)abstract
- Today, many of the 10 million childhood deaths each year are caused by diseases of poverty--diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality. In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.
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| 25. |
- Chaquisse, Eusebio, et al.
(författare)
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Sexual and physical intimate partner violence among women using antenatal care in Nampula, Mozambique
- 2018
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Ingår i: Journal of Public Health in Africa. - : PAGEPress. - 2038-9922 .- 2038-9930. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.
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| 26. |
- Chaquisse, Eusébio, et al.
(författare)
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Sexual and physical intimate partner violence among women using antenatal care in Nampula, Mozambique
- 2018
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Ingår i: Journal of Public Health in Africa. - : Oxford University Press (OUP). - 2038-9922 .- 2038-9930 .- 1464-360X .- 1101-1262. ; 9:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.
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| 27. |
- Chaquisse, E, et al.
(författare)
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Sexual and physical intimate partner violence among women using prenatal care in Nampula, Mozambique
- 2015
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Konferensbidrag (refereegranskat)abstract
- AbstractBackground: Intimate partner violence (IPV) is a major public health problem worldwide but research on IPV in Africa remains limited. This study aims to estimate the prevalence of sexual and physical intimate partner violence against women and its associated factors, in a sample of women using prenatal care in Nampula, province-Mozambique.Methods: This is a cross-sectional study, carried out in six health units, from February 2013 to January 2014. One in every three pregnant women who visited primary health facilities for the first pre-natal appointment was eligible and invited to participate. After obtaining informed consent 869 pregnant answered the Conflict Tactics Scale 2. Odds ratios (OR) and respective 95% confidence intervals (95%CI) were calculated by using Logistic Regression.Results: The prevalence of sexual abuse ever in life was 49% and of physical abuse was 46%. The past year prevalence was 46% and 44% for sexual and physical abuse, respectively. Sexual abuse and physical violence occurred in every age group. Significant associations were found between previous neonatal deaths and being physically abused, during the life-time (OR= 3.00, 95% IC: 1.67 to 5:39), and the past year (OR=3.23, 95% CI: 1.80 - 5.80).Conclusion: This study found a high lifetime and past year violence prevalence among women using prenatal care in Mozambique. Prenatal care provides a window of opportunity for identifying women who experience violence.Message 1The prevalence of intimate partner violence is very high among women in Mozambique and prenatal care can be a sentinel settingMessage 2The implementation of strategies to support women victims of violence in Mozambique is urgently needed
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| 28. |
- Chowdhury, Ehsanul, 1977-, et al.
(författare)
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CSR Reporting of Stakeholders’ Health: Proposal for a New Perspective
- 2021
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Ingår i: Sustainability. - : MDPI. - 2071-1050. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the paper is to identify and categorize disclosures from the Global Reporting Initiative Sustainability Reporting Standards (GRI Standards) that have direct or indirect influence on health of external or internal stakeholders.Methodology: GRI core and comprehensive disclosures (as part of universal standards and topic-specific standards related to economic, environmental and social topics) that can be used by businesses for CSR reporting were grouped as to have direct or indirect influence on external and internal stakeholders’ health.Findings: The study proposes a systematic way of conceiving GRI standards in terms of direct or indirect influence on the health and well-being of internal and external stakeholders.Originality/Value: This is the first study that provides a classification of core and comprehensive GRI disclosures that have direct or indirect influence on the health of external or internal stakeholders. This classification will allow businesses to easily report those CSR activities that might be of importance to stakeholders’ health promotion.
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| 29. |
- Csöff, Rosina-Martha, et al.
(författare)
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Körperliche beschwerden bei älteren migranten in Deutschland
- 2010
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Ingår i: Zeitschrift für Psychiatrie, Psychologie und Psychotherapie. - : Hogrefe Publishing Group. - 1661-4747 .- 1664-2929. ; 58:3, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.
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| 30. |
- Csöff, Rosina-Martha, et al.
(författare)
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Körperliche Beschwerden bei älteren Migranten in Deutschland [Somatic Complaints among Elderly Migrants in Germany]
- 2010
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Ingår i: Zeitschrift für Psychiatrie, Psychologie und Psychotherapie. - : Hogrefe Publishing Group. - 1661-4747 .- 1664-2929. ; 58:3, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- Bodily complaints are widespread among the elderly; few surveys investigating bodily complaints among elder migrants exist in Germany and internationally. Our multi-centric cross section study examined bodily complaints among persons between 60 and 84 years dwelling in Stuttgart on the basis of the short version of the Giessen Complaint Questionnaire (GBB-24). In Germany 648 were explored with 13.4% (n = 87) born outside of Germany. Gender distribution was equal among migrants and non-migrants; socioeconomic status was lower among the migrants: 8.0% (n = 7) of the migrants and 2.5% (n = 14) of the non-migrants had at most four years of education; 12.6% (n = 11) of the migrants and 8.2% (n = 46) of the non-migrants held a net income of below 1000 (sic); 26.4% of the migrants and 38.1% (n = 214) of the non-migrants disposed over 2000 (sic) monthly. The incidence of somatic complaints was 65.5% (n = 57) among the migrants and 55.8% (n = 313) among the non-migrants. Women (61.8%) displayed more often somatic complaints than men (51.8%). Somatic complaints increased with age. Except of the group aged between 70-74 years no significant difference between migrants and non-migrants could be shown concerning the incidence of bodily complaints. Outlook: population based studies on bodily complaints among migrants are urgently needed.
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| 31. |
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| 32. |
- Cutts, F T, et al.
(författare)
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Child and Maternal Mortality during a Period of Conflict in Beira City, Mozambique
- 1996
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 25:2, s. 349-356
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Tidskriftsartikel (refereegranskat)abstract
- Background Child mortality rates have been declining in most developing countries. We studied child and maternal mortality and risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. Methods A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality (‘children ever born’ method and Preceding Birth Techniques [PBT]), and maternal mortality sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. Results Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, 5q0 per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate for 1990/91 was 154 (95% confidence interval(CI): 124–184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio[OR] = 2.0, 95% CI: 1.1–3.8), absence of the father (OR = 2.4, 95% CI: 1.2–4.8), low paternal educational level (OR = 2.1, 95% CI: 0.8–5.4), young maternal age (OR = 2.0, 95% CI: 1.0–3.7), self-reported maternal illness (OR = 2.4, 95% CI: 1.2–4.9), and home delivery of the child (OR = 2.3, 95% CI: 1.2–4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. Conclusions Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.
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| 33. |
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| 34. |
- de Rijke, Chris, et al.
(författare)
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Living Structure as an Empirical Measurement of City Morphology
- 2020
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Ingår i: ISPRS International Journal of Geo-Information. - : MDPI. - 2220-9964. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- Human actions and interactions are shaped in part by our direct environment. The studies of Christopher Alexander show that objects and structures can inhibit natural properties and characteristics; this is measured in living structure. He also found that we have better connection and feeling with more natural structures, as they more closely resemble ourselves. These theories are applied in this study to analyze and compare the urban morphology within different cities. The main aim of the study is to measure the living structure in cities. By identifying the living structure within cities, comparisons can be made between different types of cities, artificial and historical, and an estimation of what kind of effect this has on our wellbeing can be made. To do this, natural cities and natural streets are identified following a bottom-up data-driven methodology based on the underlying structures present in OpenStreetMap (OSM) road data. The naturally defined city edges (natural cities) based on intersection density and naturally occurring connected roads (natural streets) based on good continuity between road segments in the road data are extracted and then analyzed together. Thereafter, historical cities are compared with artificial cities to investigate the differences in living structure; it is found that historical cities generally consist of far more living structure than artificial cities. This research finds that the current usage of concrete, steel, and glass combined with very fast development speeds is detrimental to the living structure within cities. Newer city developments should be performed in symbiosis with older city structures as a whole, and the structure of the development should inhibit scaling as well as the buildings themselves.
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| 35. |
- Dgedge, M, et al.
(författare)
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The burden of disease in Maputo city, Mozambique : registered and autopsied deaths in 1994
- 2001
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Ingår i: Bulletin of the World Health Organization. - 0042-9686 .- 1564-0604. ; 79:6, s. 546-552
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals.Methods: Data were taken from the Maputo City death register and autopsy records for 1994.Findings: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritionaldisorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leadingcauses of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814);tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovasculardiseases (269); homicide (188); and bacterial meningitis (178).Conclusions: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported.With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.
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| 36. |
- Eriksson, Ann-Kristin Mimmi
(författare)
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Vid utmattningens gräns. Utmattningssyndrom som existentiellt tillstånd : Vårdtagares och vårdgivares erfarenheter av utmattningssyndrom och rehabilitering med en existentiell ansats i svensk vårdkontext
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives: Stress-related illness is a growing public health problem in Sweden and it is the most common reason for sick leave today. Stress-related illness causes suffering on a number of levels and affects the patient’s health and life in the long term. The stress-related ill health also leads to consequences for society, causing high costs for sick leave and health care as well as lost workforce since people partially or entirely lose their capacity to work. Research on stress-related ill health and rehabilitation often underline work-related conditions as crucial in dealing with the problem. There is also research that points out psychosocial factors in understanding stress-related ill health. What we know little about is the existential perspective of clinical burn-out. Therefore, it is of importance to investigate people’s existential experiences of clinical burn-out and the significance of an existential perspective in rehabilitation.Aim: The overall aim of this thesis is to gain insight into the existential experience of clinical burn-out as well as to highlight the significance of an existential perspective in rehabilitation. In addition, the thesis aims to reach a deeper understanding of clinical burn-out from an existential point of view and contribute to the field with knowledge of the existential dimension of health.Methods: The study, conducted in 2011, is based on qualitative interviews made with an inductive hermeneutic approach. Five patients and seven care givers were interviewed, focusing their existential experiences of clinical burn-out as well as their experiences of rehabilitation with an existential approach. A strategic selection was made of informants in the context of a rehabilitation program with an existential approach for people diagnosed with clinical burn-out. The data was analysed in two steps. In the first step the data was interpreted with an inductive hermeneutic approach. In step two of the analysis, the data was interpreted with a deductive hermeneutic approach, using Karl Jasper’s concept of limit situation as a way of interpreting the existential experience. Aaron Antonovsky’s concept sense of coherence was used as a tool for understanding components that can contribute to restoring health.Results: In this study, the patients describe clinical burn-out as a comprehensive existential experience that can be perceived as being in between life and death, in a shadow world, trapped in a dead end. It’s a situation characterized by being powerless. It creates a need to comprehend one’s situation in order to be able to regain control and manage it. It’s a struggle to make sense of the life situation. When not being met with understanding, the patients lose hope. Existential issues in terms of meaning, existence and life choices become urgent. Working with the existential perspective requires trust, openness from both caregiver and patient, distinctness, a way to communicate it and courage to take on the challenge of dealing with existential issues. The perspective also requires that the existential suffering can be contained. Dealing with existential questions leads to self-knowledge and insights that enables a possibility to make different choices and leave negative behavioural patterns. Also, it can lead to a discovery of spirituality and religion as a resource in life. Besides their personal struggle for meaning, the patients see an existential void in society, leaving people without tools to handle existential needs. This is understood as something that affects people’s ability to handle stressful times in life.The care providers understand burn-out as a manifestation of a way of living that is not sustainable. It is an existential experience embodied in body and mind that can be experienced as being drained of life. It’s an existential challenge, causing grief when realizing one’s limitations as a human being. Also, loss of meaning and sense of existential vulnerability due to an experience of being annihilated is crucial for understanding the deep existential crisis that clinical burn-out can induce. This situation makes the patient ask existential questions about identity, meaning, values and direction. In the burnout-process the patients have distanced themselves from their own self and therefore need to reconnect with themselves. This makes the existential questions central in the rehabilitation as a way to reconnect to inner strength and resources, which are prerequisites for starting a health promoting, sustainable process which is empowering, making it possible to see oneself as a human being who experience meaning, not only as a patient with a diagnosis. Instead of finding meaning in the diagnosis, the patient’s existential questions and the existential experience is a key to moving forward, out of the situation. Meaning-making is therefore important in the rehabilitation.A holistic-existential approach and view of man makes it possible to work with the complexity of the situation. The holistic-existential approach creates synergies and offers an extra tool both for the caregiver and the patient. Focusing on the patient’s resources and competence makes it possible to see the crisis as a way to learn from it.The existential perspective in health care and rehabilitation is enabled by competence, openness, reliance, empathy and respect when meeting the patient. It also requires courage to take on the challenge of dealing with existential issues. It can be hard for both the patient and the care giver to confront existential suffering. It is the responsibility of the care giver to enable the existential perspective by acknowledging and making the existential perspective possible to communicate and work it through.The care providers understands values in modern society as contributing to people’s experience of feeling alone with existential needs, which intensifies their existential aloneness.The care providers’ experience is that the biomedical paradigm aggravates an existential perspective. The perspective is not associated with the care situation. There is a lack of knowledge about and understanding of the value of the existential perspective, all the way from the decision-making level to the clinical meeting with the patient. In addition, the paradigm affects how the patients express their illness. Also, the perspective requires time. Existential perspectives, therefore, tend to be concealed in the health care context.Applying Karl Jasper’s concept of limit situation, clinical burn-out can be interpreted as a defining existential experience. It can be understood as a limit situation when humans realize their limitations and at the same time get insights that are crucial for their lives. It’s an experience they wish they had not gone through, but on the other hand, it has led to insights they do not want to be without. The meaning-making process is health promoting by recreating meaning, the fundamental part of sense of coherence, which is crucial for a salutogenic direction.Conclusion: The existential state that the clinical burnout patients go through can, using Karl Jasper’s concept, be understood as a limit situation. According to Jasper’s reasoning, the limit situation can be perceived as facing an abyss, making it clear one has limitations as a human being. At the same time, the experience can be perceived as reaching a limit where humans can get insights about human life that can enhance life. Clinical burn-out, using Aaron Antonovsky’s concept, can be understood as a loss of the components that create sense of coherence. Loss of meaning is particularly central for understanding burn-out.Consequently, it is crucial to acknowledge the existential challenge that the patient is facing, as well as the importance of the meaning-making process for facilitating a movement in a health promoting manner. It gives a deeper understanding of the challenges and needs of patients suffering from clinical burn-out.The existential dimension of health has been highlighted in health promotion, but gets little attention in practice. This is especially significant in the health care context. This points out the need for a discussion about how the existential health dimension can be used as a resource in health care and rehabilitation and how this resource for health can be applied in a better way in health promotion and public health.
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| 37. |
- Eslami, Bahareh, et al.
(författare)
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Anxiety, depressive and somatic symptoms in adults with congenital heart disease
- 2013
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Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 74:1, s. 49-56
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveDespite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).MethodsIn cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.ResultsIn bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.ConclusionsCongenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.
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| 38. |
- Eslami, Bahareh, et al.
(författare)
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Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country
- 2013
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Ingår i: Cardiology in the Young. - 1047-9511 .- 1467-1107. ; 23:02, s. 209-218
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Tidskriftsartikel (refereegranskat)abstract
- Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.
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| 39. |
- Eslami, Bahareh, et al.
(författare)
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Life-time abuse and mental health among older persons : a European study
- 2017
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Ingår i: Journal of Aggression, Maltreatment & Trauma. - : Informa UK Limited. - 1092-6771 .- 1545-083X. ; 26:6, s. 590-607
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.
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| 40. |
- Eslami, Bahareh, et al.
(författare)
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Quality of life and life satisfaction among adults with and without congenital heart disease in a developing country
- 2015
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:2, s. 169-179
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Tidskriftsartikel (refereegranskat)abstract
- Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.Design Cross-sectional case-control.Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.
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| 41. |
- Eslami, Bahareh, et al.
(författare)
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Style of Coping and its Determinants in Adults with Congenital Heart Disease in a Developing Country
- 2014
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Ingår i: Congenital Heart Disease. - : Computers, Materials and Continua (Tech Science Press). - 1747-079X .- 1747-0803. ; 9:4, s. 349-360
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.DesignThe study has a cross-sectional case-control design.SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.
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| 42. |
- Eslami, Bahareh, et al.
(författare)
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The prevalence of lifetime abuse among older adults in seven European countries
- 2016
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Ingår i: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 61:8, s. 891-901
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics).Methods This cross-sectional population-based study had 4467 participants, aged 60–84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people.Results Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain.Conclusions High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.Keywords Determinant Elder abuse Financial Injuries Psychological Sexual
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| 43. |
- Eslami, Bahareh, 1978-
(författare)
-
The Psychosocial Situation of Adults with Congenital Heart Disease in Iran
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives:Adults with congenital heart disease (CHD) are a new group of patients with a prevalence of 4 per 1000. They have evolved as a result of significant improvements in medical management during the past decades. However, adults with CHD experience various medical and social challenges that may influence their psychosocial functioning. Providing appropriate medical, rehabilitation and social care for adults with CHD, and indeed improving their well-being require the evaluation of their current psychosocial situation. This thesis aims to increase the understanding of the mental health, somatic symptoms, social support, style of coping, quality of life and life satisfaction of adults with CHD and to examine the possible contributing factors in the context of a developing country; issues not addressed in the current literature.Methods:This thesis is based on four studies. Study I recruited 347 consecutive CHD patients (18-64 years) from two heart hospitals in Tehran, Iran. The study iscross-sectional and focused on sex differences in socio-economic status, lifestyle and medical characteristics of adults with CHD. Studies II, III and IV havea cross-sectional case-control design comparing the aforementioned CHD patients with 353 non-CHD participants, matched by sex and age. Outcome variables were anxiety, depressive and somatic symptoms (Study II), styles of coping (Study III), and life satisfaction/quality of life (Study IV). The data were analysed with bivariate and multivariate methods. Multivariate linear regression analyses were performed to scrutinize the association of demographic/socio-economic variables, social support, mental health, and medical variables with the aforementioned outcome variables among adults with CHD (Studies II, III, IV). Results:Study I showed that women with CHD were more often married and had children and were less often employed, but had healthier behaviour compared to men. Even though most of the patients received regular medical viiicare from different typesof medical professionals, half of them had no knowledge about the type of their cardiac defect. Study II showed that CHD patients experienced more anxiety and somatic symptoms than the healthy controls, whereas there were no differences in depressive symptoms. Perceived financial strain, lower social support and low annual income were positively associated with worse outcome in mental health and somatic symptoms. None of the medical variables were related to anxiety, depressive and somatic symptoms. Study III showed that the styles of coping of the CHD patients were comparable to those of the control group and CHD per se was not associated with a certain style of coping, except for palliative reaction pattern. Problem-focused styles of coping were associated with being never married, parenthood, higher level of anxiety and somatic symptoms, lower level of depressive symptoms and higher social support. Emotion-focused styles of coping were associated with annual income and higher level of anxiety. None of theadopted coping strategies were related to the heart disease variables. Study IV showed that adults with CHD had poorer quality of life and lower life satisfaction than the control group. However, CHD was associated only with decreased overall quality of life and its physical health domain, and life and health satisfaction. Among CHD patients, higher quality of life was associated with female sex, younger age, employment status, having less emotional distress and higher social support, while life satisfaction was associated with female sex, being employed, less emotional distress and higher social support. Conclusions:The results support the notion that psychosocial factors contribute to the well-being of adults with CHD.Socio-economic factors, emotional health and social support are significant determinants in nearly all outcomes of interest which need to be considered by health care providers and policy makers in their efforts to improve the health ofadults with CHD. However, longitudinal studies are warranted to establish causal linksand qualitative studies are recommended to deepen the understanding of coping and quality of life.
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| 44. |
- Fraga, S, et al.
(författare)
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Lifetime Abuse and Quality of Life among Older People
- 2017
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Ingår i: Health & Social Work. - : Oxford University Press (OUP). - 0360-7283 .- 1545-6854. ; 42:4, s. 215-222
-
Tidskriftsartikel (refereegranskat)abstract
- Few studies have evaluated the impact of lifetime abuse on quality of life (QoL) among older adults. By using a multinational study authors aimed to assess the subjective perception of QoL among people who have reported abuse during the course of their lifetime. The respondents (N = 4,467; 2,559 women) were between the ages of 60 and 84 years and living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Lifetime abuse was assessed by using a structured questionnaire that allowed to assess lifetime experiences of abuse. QoL was assessed with the World Health Organization Quality of Life–Old module. After adjustment for potential confounders, authors found that to have had any abusive experience decreased the score of sensory abilities. Psychological abuse was associated with lower autonomy and past, present, and future activities. Physical abuse with injuries significantly decreased social participation. Intimacy was also negatively associated with psychological abuse, physical abuse with injury, and sexual abuse. The results of this study provide evidence that older people exposed to abuse during their lifetime have a significant reduction in QoL, with several QoL domains being negatively affected.
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| 45. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Corporate social responsibility and external stakeholders’ health and wellbeing: A viewpoint
- 2020
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Ingår i: Journal of Public Health Research. - : SAGE Publications. - 2279-9028 .- 2279-9036. ; 9:1, s. 27-30
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Tidskriftsartikel (refereegranskat)abstract
- In recent years there has been increased interest in the roleplayed by business corporate social responsibility (CSR) strategiesin promoting the health and wellbeing of internal and externalstakeholders. However, the sparse public health research to datehas mainly focused on the health and wellbeing of internal stakeholders.This viewpoint article aims to ignite discussion of howCSR strategies need to also target external stakeholders beyondthe workplace. Businesses have an opportunity to help address themost important societal challenges, especially the social determinantsof health which are the root causes of inequities in health.However, while advancing a new agenda for promoting externalstakeholders’ health, businesses need to take into account potentialchallenges that might arise from ethical conflicts when trying tobalance their CSR initiatives against their business operations.
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| 46. |
- Hiswåls, Anne-Sofie
(författare)
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Employment Status and Inequalities in Health Outcomes : Population-based Studies from Gävleborg County
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and objectives: From a public health perspective, it is important not only to improve and maintain health, but also to promote equality in health. Epidemiological research has showed the importance of work and unemployment in the development of socio-economic health inequalities, and peoples life chances are suggested to be conditioned by participation or exclusion from the labour market. The most recent economic recession has brought further changes to the labour market that might have aggravated the already multifaceted image of inequalities in health. Gävleborg County was one of the hardest hit counties in Sweden, which experienced a myriad of changes in the labour market that went beyond those of the Swedish national average, in terms of increase in flexible forms of employment, factory closures, and lay-offs. The overall objective of this thesis was to investigate the relationship between employment status and health-related inequalities in Gävleborg County, Sweden. In addition, the Specific objectives for the thesis were to: assess the relationship between employment status and self-reported health in Gävleborg (Study I); to estimate the relationship between employment status and suicidal ideation during the economic recession in Gävleborg (Study II); to estimate the prevalence of anxiety and depression among economically active people living in the Municipality of Gävle (Study III) and to assess experiences and perceptions of well-being after involuntary job loss in Gävle (Study IV).Methods: Study I and II in this thesis used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Study III was performed in Wave 1 (baseline survey) of the Gävle Household, Labour Market Dynamics and Health Outcomes survey (GHOLDH), a panel survey with household as the follow-up unit. A total of 241 persons completed a self-administered postal questionnaire which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18–65 years. The thesis used descriptive analyses and logistic regression models to describe and explore the relationship between employment status, self-reported health and suicidal ideation in Gävleborg County (Studies I and II). Descriptive analysis of means and a multiple regression analysis for adjusted means of HADS, were used in order to estimate the prevalence of anxiety and depression among economically active persons residing in the Gävle Municipality (Study III). Study IV used a qualitative approach to gain a deeper understanding of how involuntarily unemployed persons in Gävlexperceive their well-being. Sixteen unemployed men and women aged 28–62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts in Study IV were analysed using thematic analysis.Results: In Study I, the prevalence of poor self-reported health (SRH) was twice as high in the group of people who were not employed (42%) compared to the employed group (21.6%). Individuals outside the labour market had odds of poor health of 2.64 (Cl 2.28–3.05) compared to their employed counterparts. Controlling for other covariates reduced the risk slightly to 2.10 (1.69–2.60), but remained statistically significant. Moreover, other variables such as long-standing illness, age, income and lack of social support were associated with self-reported poor health. In Study II, among those not employed, 11.2% had been in a situation where they had seriously considered taking their life (at some time during the past 12 months). The corresponding figure for those employed was 2.9%. Unadjusted results of the logistic regression analysis revealed that people who were not employed had about a four times higher risk of suicidal ideation, with an OR of 4.21 (CI: 3.14–5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14–5.64) in model I, to 1.73 (CI 1.16–2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. In Study III, the prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97–9.75) and 4.67 (3.60–5.74) for depression. Study IV revealed six different themes from the interviews: Work was perceived as the basis for belonging; loss of work affected people’s social life and consumption patterns due to changes in their financial situation. Feelings of isolation, loss of self-esteem, and feelings of hopelessness were reported, affecting the respondents’ physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. Activities, structure, and affiliation in other contexts were reported as part of their strategy for coping with poor mental health.Conclusion: This thesis found a statistically significant relationship between being outside the labour market and poor SRH, a high risk of suicidal ideation, anxiety, and depression during the recent economic recession. The relationship between employment status and SRH was partially explained by socioeconomic, demographic and lifestyle variables. In addition, the relationship between employment status and suicidal ideation was, for the most part, explained by demographic, socio-economic and self-reported psychological variables. Atxithe municipal level, the prevalence of anxiety and depression was higher among those who were out of the labour market as compared to those who were employed and the odds of anxiety and depression were higher among people out of the labour market, but this was less prominent for depression than for anxiety. Job loss created feelings of loss of dignity and belonging as a human being. The participants experienced feelings of worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having activities other than work gave structure and meaning to everyday life. The results of this thesis indicate a need for early detection and potential treatment of people out of the labour force and for being aware of the increased risk of poor health symptoms and disorders among unemployed individuals. The findings also indicate a need for primary prevention strategies, implying that policy-makers must pay attention to the health status of those who are out of work, especially during times of combined economic hardship and labour market fluctuations. However, longitudinal studies are warranted to shed further light on the mechanisms through which employment status and conditions impact physical and psychological health outcomes.
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| 47. |
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| 48. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Employment Status and Suicidal Ideation during Economic Recession
- 2015
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Ingår i: Health science journal. - 1791-809X. ; 9:1, s. 1-9
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County.Method:The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideationResults:Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation.Conclusion:There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.
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| 49. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Employment Status, Anxiety and Depression in a Municipal Context
- 2017
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Ingår i: Research in Health Science. - : Scholink Co, Ltd.. - 2470-6213 .- 2470-6213 .- 2470-6205. ; 2:1, s. 12-23
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:This study aimed to investigate the prevalence of anxiety and depression by employment status among a sample of the working age population residing in Gävle Municipality in Sweden.Methods: A total of 241 persons completed a self-administered postal questionnaire in the baseline survey of the Gävle Household, Labour Market and Health Outcomes (GHOLDH) survey, which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.Results: The prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour marketas compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.
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| 50. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Experiences of unemployment and well-being after jobb loss during economic recession : results of a qualitative study in East Central Sweden
- 2017
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Ingår i: Journal of Public Health Research. - : SAGE Publications. - 2279-9028 .- 2279-9036. ; 6:3, s. 135-141
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.
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