| 1. |
- de Zwarte, Sonja M. C., et al.
(author)
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Intelligence, educational attainment, and brain structure in those at familial high-risk for schizophrenia or bipolar disorder
- 2022
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In: Human Brain Mapping. - : John Wiley & Sons. - 1065-9471 .- 1097-0193. ; 43:1, s. 414-430
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Journal article (peer-reviewed)abstract
- First-degree relatives of patients diagnosed with schizophrenia (SZ-FDRs) show similar patterns of brain abnormalities and cognitive alterations to patients, albeit with smaller effect sizes. First-degree relatives of patients diagnosed with bipolar disorder (BD-FDRs) show divergent patterns; on average, intracranial volume is larger compared to controls, and findings on cognitive alterations in BD-FDRs are inconsistent. Here, we performed a meta-analysis of global and regional brain measures (cortical and subcortical), current IQ, and educational attainment in 5,795 individuals (1,103 SZ-FDRs, 867 BD-FDRs, 2,190 controls, 942 schizophrenia patients, 693 bipolar patients) from 36 schizophrenia and/or bipolar disorder family cohorts, with standardized methods. Compared to controls, SZ-FDRs showed a pattern of widespread thinner cortex, while BD-FDRs had widespread larger cortical surface area. IQ was lower in SZ-FDRs (d = -0.42, p = 3 × 10-5 ), with weak evidence of IQ reductions among BD-FDRs (d = -0.23, p = .045). Both relative groups had similar educational attainment compared to controls. When adjusting for IQ or educational attainment, the group-effects on brain measures changed, albeit modestly. Changes were in the expected direction, with less pronounced brain abnormalities in SZ-FDRs and more pronounced effects in BD-FDRs. To conclude, SZ-FDRs and BD-FDRs show a differential pattern of structural brain abnormalities. In contrast, both had lower IQ scores and similar school achievements compared to controls. Given that brain differences between SZ-FDRs and BD-FDRs remain after adjusting for IQ or educational attainment, we suggest that differential brain developmental processes underlying predisposition for schizophrenia or bipolar disorder are likely independent of general cognitive impairment.
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| 2. |
- Lindert, J, et al.
(author)
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Abuse and neglect of older persons in 7 cities in seven countries in Europe : a cross sectional community study
- 2013
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In: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 58:1, s. 121-132
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Journal article (peer-reviewed)abstract
- ObjectivesWe aimed to investigate the prevalence rate of abuse (psychological, physical, sexual, financial, neglect) of older persons (AO) in seven cities from seven countries in Europe (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden), and to assess factors potentially associated with AO.MethodsA cross-sectional study was conducted in 2009 (n = 4,467, aged 60–84). Potentially associated factors were grouped into domains (domain 1: age, gender, migration history; domain 2: education, occupation; domain 3: marital status, living situation; domain 4: habitation, income, financial strain). We calculated odds ratios (OR) with their respective 95 % confidence intervals (CI).ResultsPsychological AO was the most common form of AO, ranging from 10.4 % (95 % CI 8.1–13.0) in Italy to 29.7 % (95 % CI 26.2–33.5) in Sweden. Second most common form was financial AO, ranging from 1.8 % (95 % CI 0.9–3.2) in Sweden to 7.8 % (95 % CI 5.8–10.1) in Portugal. Less common was physical AO, ranging from 1.0 % (95 % CI 0.4–2.1) in Italy to 4.0 % (95 % CI 2.6–5.8 %) in Sweden. Sexual AO was least common, ranging from 0.3 (95 % CI 0.0–1.1) in Italy and Spain to 1.5 % (95 % CI 0.7–2.8) in Greece. Being from Germany (AOR 3.25, 95 % CI 2.34–4.51), Sweden (OR 3.16, 95 % CI 2.28–4.39) or Lithuania (AOR 2.45, 95 % CI 1.75–3.43) was associated with increased prevalence rates of AO.ConclusionCountry of residence of older people is independent from the four assessed domains associated with AO. Life course perspectives on AO are highly needed to get better insight, and to develop and implement prevention strategies targeted at decreasing prevalence rates of AO.
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| 3. |
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| 4. |
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| 5. |
- Fraga, S, et al.
(author)
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Lifetime Abuse and Quality of Life among Older People
- 2017
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In: Health & Social Work. - : Oxford University Press (OUP). - 0360-7283 .- 1545-6854. ; 42:4, s. 215-222
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Journal article (peer-reviewed)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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| 6. |
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| 7. |
- Stankuniene, A., et al.
(author)
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Causes of refraining from buying prescribed medications among the elderly in Kaunas, Lithuania
- 2011
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In: Medicina. - : MDPI AG. - 0025-7680 .- 1669-9106. ; 47:5, s. 291-296
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Journal article (peer-reviewed)abstract
- Background and Objective: Accessibility to medications among the elderly is a source of concern in Lithuania and beyond. However, there are no studies carried out on this topic in Lithuania. Therefore, the aim of this study was to evaluate the causes of refraining from buying prescribed medications among the elderly in Kaunas, Lithuania. Material and Methods:The data were collected in a cross-sectional ABUEL study in 2009. A total of 624 filled-in questionnaires (response rate, 48.9%) from the elderly aged 60-84 years living in Kaunas (Lithuania) were received. For evaluation of the impact of explanatory variables on the analyzed event (binary dependent variable), an Enter model of logistic regression was used. Results:The study showed that 32.7% of the respondents refrained from buying prescribed medications. The most common reasons (respondents could select several options) for this decision were financial problems (48.0%), disappearance of problems (40.7%), and fear of side effects (22.5%). Refraining from buying prescribed medications was positively associated with age (OR, 0.85; 95% CI, 0.74 to 0.99). Higher education was associated with a reduced risk of refraining from buying prescribed medications due to financial problems (OR, 0.49; 95% CI, 0.31 to 0.78) and an increased risk of refraining from buying medications due to the disappearance of health problems (OR, 1.75; 95% CI, 1.15 to 2.68). An opposite association with worries about daily expenses was observed. Conclusions:Study has revealed that one-third of the elderly refrained from buying prescribed medications, and the main reasons for this were financial problems and disappearance of health problems.
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| 8. |
- Tredal, Ingrid, et al.
(author)
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Alcohol use among abused and non-abused older persons aged 60-84 years : A European study
- 2013
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In: Drugs. - : Informa UK Limited. - 0968-7637 .- 1465-3370. ; 20:2, s. 96-109
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Journal article (peer-reviewed)abstract
- Aims: Describing alcohol use by abuse type (e.g. psychological) and considering other factors (e.g. depression).Methods: The respondents were 4467 (2559 women, 57.3%) randomly selected elders (60–84 years) from seven European cities. The cross-sectional data were collected with scales covering various areas and examined with bivariate/multivariate methods.Findings: Psychologically abused elders were more often alcohol users than non-users (21.7% vs. 16.3%) and the opposite regarding financially abused elders (4.8% vs. 3.5%). Psychologically abused elders also had more often three or more drinks containing alcohol in a drinking day (21.1% vs. 16.1%) and six or more drinks on one occasion (24.5% vs. 18.3%). Psychological abuse, demographics/socio-economics (e.g. education), smoking and leisure activities were positively associated alcohol use, and being from certain countries (e.g. Italy), age (e.g. 80–84 years), depression and financial abuse negatively.Conclusions: Across countries, 64.2% of the elders were drinkers. Some variables (e.g. psychological abuse) were positively related to alcohol use and others (e.g. depression) negatively. Many of the elders were exposed to abuse. Our findings may be useful to prevent/manage drinking and abuse among elders. However, alcohol use was influenced by various factors that need to be further elucidated, particularly the relation between abuse and drinking.
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| 9. |
- Costa, D, et al.
(author)
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Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries
- 2014
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; , s. Art. no. 49-
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Journal article (peer-reviewed)abstract
- Background:Different service characteristics are known to influence mental health care delivery. Much less isknown about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of careto socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health carefor marginalized groups in 14 European capital cities and to explore the associations between organisationalquality, service features and country-level characteristics.Methods:617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index ofService Organisation (QISO) was developed and applied across all sites. Service characteristics and country levelsocioeconomic indicators were tested and related with the Index using linear regressions and random interceptlinear models.Results:The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) inIreland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristicsignificantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inverselyassociated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, withGDP explaining 12% of this variance.Conclusions:Socioeconomic contextual factors, in particular the national GDP are likely to influence theorganisational quality of services providing mental health care for marginalized groups. Such factors should beconsidered in international comparative studies. Their significance for different types of services should be exploredin further research.Keywords:Mental health services, Quality index of service organization, Socially marginalized groups,Multi-level analysis
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| 10. |
- Costa, D., et al.
(author)
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Male and female physical intimate partner violence and socio-economic position : a cross-sectional international multicentre study in Europe
- 2016
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In: Journal of Public Health. - UK : Elsevier. - 2198-1833 .- 1613-2238. ; 139, s. 44-52
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Journal article (peer-reviewed)abstract
- ObjectivesThis work explores the association between socio-economic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional).Study designCross-sectional international multicentre study.MethodsA sample of 3496 men and women, (aged 18–64 years), randomly selected from the general population of residents from six European cities was assessed: Athens; Budapest; London; Östersund; Porto; and Stuttgart. Their education (primary, secondary and university), occupation (upper white collar, lower white collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales.ResultsPast year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs university) was associated with female victimisation (adjusted odds ratio, 95% confidence interval: 3.2; 1.3–8.0) and with female bidirectional IPV (4.1, 2.4–7.1). Blue collar occupation (vs upper white) was associated with female victimisation (2.1, 1.1–4.0), female perpetration (3.0, 1.3–6.8) and female bidirectional IPV (4.0, 2.3–7.0). Unemployment duration was associated with male perpetration (>12 months of unemployment vs never unemployed: 3.8; 1.7–8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2–2.7; men: 1.7, 1.0–2.8).ConclusionsIn these European centres, physical IPV was associated with a disadvantaged SEP. A consistent socio-economic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Strassmayr, C, et al.
(author)
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Mental health care for irregular migrants in Europe : Barriers and how they are overcome
- 2012
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12:367, s. Art. no. 367-
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Journal article (peer-reviewed)abstract
- BackgroundIrregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice.MethodsData from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis.ResultsExperts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation.ConclusionsEven in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources.
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| 15. |
- Welbel, M, et al.
(author)
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Addiction treatment in deprived urban areas in EU countries: Accessibility of care for people from socially marginalized groups
- 2013
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In: Drugs. - : Informa UK Limited. - 0968-7637 .- 1465-3370. ; 20:1, s. 74-83
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Journal article (peer-reviewed)abstract
- Aim: This study examines the accessibility of addiction treatment within services providing mental health care and support for people from socially marginalized groups in deprived urban areas across EU countries.Methods: Services providing mental health care and support in deprived areas of 14 EU capital cities were assessed with a questionnaire. We analysed the availability and accessibility of those services providing addiction treatment for people from six groups: the long-term unemployed, the homeless, street sex workers, asylum seekers and refugees, irregular migrants and people from travelling communities.Results: While 30% of all the assessed services provided addiction treatment, in 20% of services, addiction was a criterion for exclusion. Among services providing addiction treatment, 77% accepted self-referrals, 63% were open on weekends or in the evening, 60% did not charge any out-of-pocket fees, 35% provided access to interpreters, and 28% ran outreach activities. These results varied substantially among EU capitals.Conclusion: Access to addiction treatment for socially marginalized groups varies across Europe. Some of the models identified may constitute barriers to treatment. Developing care delivery models that facilitate access for vulnerable populations should be a priority for national and European policies.
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| 16. |
- Abbasi, Seyed H, et al.
(author)
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Gender Differences in the Risk of Coronary Artery Disease in Iran
- 2012
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In: Iranian Journal of Public Health. - 0304-4556. ; 41:3, s. 36-47
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Journal article (peer-reviewed)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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| 17. |
- Arab-Zozani, Morteza, et al.
(author)
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The prevalence of elder abuse and neglect in Iran : A systematic review and meta-analysis
- 2018
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In: Journal of Elder Abuse & Neglect. - : Informa UK Limited. - 0894-6566 .- 1540-4129. ; 30:5, s. 408-423
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I2 statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.
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| 18. |
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| 19. |
- Costa, Diogo, et al.
(author)
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Intimate partner violence in Europe: design and methods of a multinational study. : La violencia de pareja en Europa: diseño y métodos de un estudio multinacional
- 2013
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In: Gaceta Sanitaria. - : Elsevier BV. - 0213-9111 .- 1578-1283. ; 27:6, s. 558-561
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Journal article (peer-reviewed)abstract
- Objective To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries.Methods Women and men aged 18–65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples' representativeness.Results Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites.Conclusion The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.
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| 20. |
- Dauvrin, M., et al.
(author)
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Health care for irregular migrants : Pragmatism across Europe. A qualitative study
- 2012
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In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 5, s. Art. no. 99-
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Journal article (peer-reviewed)abstract
- Abstract. Background: Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. Results: Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. Conclusions: The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways. © 2012 Dauvrin et al; licensee BioMed Central Ltd.
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| 21. |
- Deville, Walter, et al.
(author)
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Health care for immigrants in Europe : Is there still consensus among country experts about principles of good practice? A Delphi study
- 2011
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 11, s. Art. no. 699-
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Journal article (peer-reviewed)abstract
- Background: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e. g. on the need for prioritising cultural differences, and between countries, e. g. on the need for more consistent governance of health care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.
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| 22. |
- Eriksson, Ann-Kristin Mimmi
(author)
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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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Doctoral thesis (other academic/artistic)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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| 23. |
- Eslami, Bahareh, et al.
(author)
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Anxiety, depressive and somatic symptoms in adults with congenital heart disease
- 2013
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In: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 74:1, s. 49-56
-
Journal article (peer-reviewed)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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| 24. |
- Eslami, Bahareh, et al.
(author)
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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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In: Cardiology in the Young. - 1047-9511 .- 1467-1107. ; 23:02, s. 209-218
-
Journal article (peer-reviewed)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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| 25. |
- Eslami, Bahareh, et al.
(author)
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Life-time abuse and mental health among older persons : a European study
- 2017
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In: Journal of Aggression, Maltreatment & Trauma. - : Informa UK Limited. - 1092-6771 .- 1545-083X. ; 26:6, s. 590-607
-
Journal article (peer-reviewed)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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| 26. |
- Eslami, Bahareh, et al.
(author)
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Lifetime abuse and somatic symptoms among older women and men in Europe
- 2019
-
In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 14:8
-
Journal article (peer-reviewed)abstract
- Background: Research suggests that survivors of interpersonal violence have an increasing experience of bodily symptoms. This study aims to scrutinise the association between lifetime abuse and somatic symptoms among older women and men, considering demographics/socio-economic, social support and health variables. Methods: A sample of 4,467 community-dwelling persons aged 60–84 years (57.3% women) living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden) was recruited for this cross-sectional study. Lifetime abuse (psychological, physical, sexual, financial and injury) was assessed on the basis of the UK study of elder abuse and the Conflict Tactics Scale-2, while somatic symptoms were assessed by the Giessen Complaint List short version. Results: Women reported somatic symptoms more frequently than men. Multiple regression analyses revealed that lifetime exposure to psychological abuse was associated with higher levels of somatic symptoms among both women and men, while experiencing lifetime sexual abuse was associated with somatic symptoms only among older women, after adjusting for other demographic and socio-economic variables. Country of residence, older age, and low socio-economic status were other independent factors contributing to a higher level of somatic symptoms. Conclusions: The positive association between the experience of abuse during lifetime and the reporting of higher levels of somatic symptoms, in particular among older women, seems to suggest that such complaints in later life might also be related to the experience of mistreatment and not only to ageing and related diseases. Violence prevention throughout lifetime could help to prevent somatic symptoms in later life.
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| 27. |
- Eslami, Bahareh, et al.
(author)
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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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In: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:2, s. 169-179
-
Journal article (peer-reviewed)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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| 28. |
- Eslami, Bahareh, et al.
(author)
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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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In: Congenital Heart Disease. - : Computers, Materials and Continua (Tech Science Press). - 1747-079X .- 1747-0803. ; 9:4, s. 349-360
-
Journal article (peer-reviewed)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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| 29. |
- Eslami, Bahareh, et al.
(author)
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The prevalence of lifetime abuse among older adults in seven European countries
- 2016
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In: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 61:8, s. 891-901
-
Journal article (peer-reviewed)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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| 30. |
- Fraga, S, et al.
(author)
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Elder abuse and socioeconomic inequalities : A multilevel study in 7 European countries
- 2014
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In: Preventive Medicine. - : Elsevier BV. - 0091-7435 .- 1096-0260. ; 61, s. 42-47
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Journal article (peer-reviewed)abstract
- Objectives To compare the prevalence of elder abuse using a multilevel approach that takes into account the characteristics of participants as well as socioeconomic indicators at city and country level.Methods In 2009, the project on abuse of elderly in Europe (ABUEL) was conducted in seven cities (Stuttgart, Germany; Ancona, Italy; Kaunas, Lithuania, Stockholm, Sweden; Porto, Portugal; Granada, Spain; Athens, Greece) comprising 4467 individuals aged 60–84 years. We used a 3-level hierarchical structure of data: 1) characteristics of participants; 2) mean of tertiary education of each city; and 3) country inequality indicator (Gini coefficient). Multilevel logistic regression was used and proportional changes in Intraclass Correlation Coefficient (ICC) were inspected to assert explained variance between models.Results The prevalence of elder abuse showed large variations across sites. Adding tertiary education to the regression model reduced the country level variance for psychological abuse (ICC = 3.4%), with no significant decrease in the explained variance for the other types of abuse. When the Gini coefficient was considered, the highest drop in ICC was observed for financial abuse (from 9.5% to 4.3%).Conclusion There is a societal and community level dimension that adds information to individual variability in explaining country differences in elder abuse, highlighting underlying socioeconomic inequalities leading to such behavior.
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| 31. |
- Graham-Kevan, Nicola, et al.
(author)
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Investigating Violence and Control Dyadically in a Help-seeking Sample from Mozambique
- 2012
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In: Scientific World Journal. - : Hindawi Limited. - 1537-744X. ; , s. Art. no. 590973-
-
Journal article (peer-reviewed)abstract
- A sample of 1442 women attending a Forensic Healthcare Service provided information on their own and their partners' use of controlling behaviors, partner violence, and sexual abuse, as well as their own experiences of childhood abuse. Using Johnson's typology, the relationships were categorized as Nonviolent, Intimate Terrorism, or Situational Couple Violence. Findings suggest that help-seeking women’s experiences of intimate violence may be diverse, with their roles ranging from victim to perpetrator.1. Introduc
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| 32. |
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| 33. |
- Henderson, Charles R., et al.
(author)
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Elder maltreatment in Europe and the United States : a transnational analysis of prevalence rates and regional factors
- 2021
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In: Journal of Elder Abuse & Neglect. - : Informa UK Limited. - 0894-6566 .- 1540-4129. ; 33:4, s. 249-269
-
Journal article (peer-reviewed)abstract
- We investigated the association between type and frequency of elder maltreatment (EM) and residential setting (rural, suburban,and urban settings in the U.S. and northern and southern cities in Europe). We used data on 7,225 participants from European and U.S. cross-sectional studies to estimate rates of EM in three domains in the five settings in logistic-linear models that included setting and demographic variables and tested prespecified contrasts on settings. Northern Europe is similar to the U.S. in rate of financial exploitation; the Mediterranean has higher rates than either of the other two. For emotional and physical maltreatment, the Mediterranean is similar to the U.S; Northern Europe has higher rates. EM differs between and within settings in the U.S. and Europe. There is a need for rigorous research to examine the effects of residential settings and environment on EM. Interventions to reduce EM should be explored.
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| 34. |
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| 35. |
- Jablonska, Beata, et al.
(author)
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Pain among women: Association with socioeconomics and work conditions
- 2006
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In: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 10:5, s. 435-447
-
Journal article (peer-reviewed)abstract
- We examined pain prevalence (general/body sites) and its characteristics/consequences among a randomised sample of women from the general population between 18 and 64 years (n=3,616). We also scrutinised associations between pain and various factors (e.g. socio-economic) by means of multivariate logistic/linear regression analyses. The women completed a questionnaire assessing various areas (e.g. pain). The design was cross-sectional and data were collected during 8 consecutive weeks. Sixty-three per cent of women reported pain during the last 3 months, of which 65% during more than 3 months. The multivariate analyses revealed associations between various socio-economic factors (e.g. financial strain) and pain in general/all studied body sites. In addition, psychosocial work conditions (i.e. work strain and social support) were significantly related to pain. Moreover, the multivariate analyses conducted among women with pain indicated relationships between socio-economic/psychosocial work conditions, and pain characteristics (e.g. intensity) and consequences (i.e. disability). A large number of women from the general population suffer from pain, in particularly prolonged pain. Women in a deprived socio-economic situation not only run a higher pain risk, but also experience their pain as more severe/disabling than their more privileged counterparts. Improvements of, for example, the socio-economic status among women living in deprived social and material circumstances, along with improved working environment may be crucial to reduce women's pain problems.
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| 36. |
- Kluge, U, et al.
(author)
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Health services and the treatment of immigrants : data on service use, interpreting services and immigrant staff members in services across Europe
- 2012
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In: European psychiatry. - 0924-9338 .- 1778-3585. ; 27:Suppl 2, s. 56-62
-
Journal article (peer-reviewed)abstract
- BACKGROUND:The number of immigrants using health services has increased across Europe. For assessing and improving the quality of care provided for immigrants, information is required on how many immigrants use services, what interpreting services are provided and whether staff members are from immigrant groups.METHODS:Structured interviews were conducted with 15 health services (9 primary care, 3 emergency departments, 3 mental health) located in areas with high immigrant populations in each of 16 European countries (n=240). Responses were collected on the availability of data on service use by immigrant patients, the provision of interpreting services and immigrant staff members.RESULTS:Data on service use by immigrants were recorded by only 15% of services. More than 40% of services did not provide any form of interpreting service and 54% of the services reported having no immigrant staff. Mental health services were more likely to use direct interpreting services, and both mental health and emergency services were more likely to have immigrant staff members.DISCUSSION:For assessing and improving the quality of care provided for immigrants, there is a need to improve the availability of data on service use by immigrants in health services throughout Europe and to provide more consistent access to interpreting services.
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| 37. |
- Lindert, Jutta, et al.
(author)
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Abuse and neglect of older persons in seven cities in seven countries in Europe : a cross-sectional community study
- 2013
-
In: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 58:1, s. 121-132
-
Journal article (peer-reviewed)abstract
- Objectives: We aimed to investigate the prevalence rate of abuse (psychological, physical, sexual, financial, neglect) of older persons (AO) in seven cities from seven countries in Europe (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden), and to assess factors potentially associated with AO.Methods: A cross-sectional study was conducted in 2009 (n = 4,467, aged 60–84). potentially associated factors were grouped into domains (domain 1: age, gender, migration history; domain 2: education, occupation; domain 3: marital status, living situation; domain 4: habitation, income, financial strain). We calculated odds ratios (OR) with their respective 95 % confidence intervals (CI).Results: Psychological AO was the most common form of AO, ranging from 10.4 % (95 % CI 8.1–13.0) in Italy to 29.7 % (95 % CI 26.2–33.5) in Sweden. Second most common form was financial AO, ranging from 1.8 % (95 % CI 0.9–3.2) in Sweden to 7.8 % (95 % CI 5.8–10.1) in Portugal. Less common was physical AO, ranging from 1.0 % (95 % CI 0.4–2.1) in Italy to 4.0 % (95 % CI 2.6–5.8 %) in Sweden. Sexual AO was least common, ranging from 0.3 (95 % CI 0.0–1.1) in Italy and Spain to 1.5 % (95 % CI 0.7–2.8) in Greece. Being from Germany (AOR 3.25, 95 % CI 2.34–4.51), Sweden (OR 3.16, 95 % CI 2.28–4.39) or Lithuania (AOR 2.45, 95 % CI 1.75–3.43) was associated with increased prevalence rates of AO.Conclusion: Country of residence of older people is independent from the four assessed domains associated
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| 38. |
- Lindert, Jutta, et al.
(author)
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Age and distress of women-Results of a representative population-based study
- 2009
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In: Archives of Women's Mental Health. - : Springer Science and Business Media LLC. - 1434-1816 .- 1435-1102. ; :12, s. 173-181
-
Journal article (peer-reviewed)abstract
- Little research has been carried out on prevalence rates of distress (e.g. depression, posttraumatic stress symptoms (PTSS), hopelessness, and burnout) of women in different age groups. The aims of this study were to measure the prevalence rate of depression, posttraumatic stress symptoms, hopelessness, and burnout among women and to clarify the associations between age groups and distress. Cross sectional epidemiological study on women in Sweden (n = 6,000, aged 18–64 years, response rate 64.1%). Measures were questionnaires on socio-economic and work-related characteristics and on depression, posttraumatic stress symptoms, hopelessness, and burnout. Depression was measured with the “General Health Questionnaire” (GHQ), PTSS with the “Posttraumatic Symptom Scale”, hopelessness with the “Hopelessness Scale” and burnout with the “Shiron-Melamed Burnout Questionnaire” (SMBQ). The prevalence rate of depression varied from 12.5% to 14.1%; of posttraumatic stress symptoms from 23.5% to 33.3%; of hopelessness from 11.5% to 16%; and of burnout from 22.9% to 17.1%. Depression was not associated with age group. Hopelessness was associated with age group in univariate analysis bur not in multivariate analysis (OR = 0.7, 95% CI = 0.5–1.0). PTSS and burnout were associated with age group. Both symptoms were higher in the youngest age group, compared to the eldest age group (posttraumatic stress symptoms: OR = 1.6, 95% CI = 1.2, 2.1; burnout: OR = 1.5, 95% CI = 1.1–2.1). Younger women show higher prevalence rates of PTSS and burnout compared to elder women. The higher prevalence rates of PTSS and burnout among younger women may be associated with job strain and/or with violent life events.
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| 39. |
- Lindert, Jutta, et al.
(author)
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Study design, sampling and assessment methods of the European study “Abuse of the Elderly in the European Region”
- 2012
-
In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 22:5, s. 662-666
-
Journal article (peer-reviewed)abstract
- Background: Violence against and abuse of older persons (VAO) aged >60 years has become a prominent public health issue. From January 2009-July 2009, we conducted the cross-sectional European study 'Abuse of the elderly in the European region' (ABUEL) among community-dwelling elderly populations aged 60-84 years in Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden. We describe the cooperation, completion and response rates; the modes of recruitment and administration; and analyse differences in response rates between countries. Methods: We calculated the population fraction (respondents in each age/sex group divided by the population in the same age/sex group) and the population fraction ratio (PFR) to describe and analyse heterogeneity between countries. To analyse associations between methods and response rates we conducted cross tabulations and logistic regression analyses. Results: The response rates ranged from 18.9 in Germany to 87.4 in Portugal. Men were underrepresented in all countries (PFR<1). Cluster- and cohort-based sampling produced the highest overall response rates. Conclusion: More European and international studies investigating response behaviour in VAO research systematically are needed to gain further knowledge about the internal and external validity of research on VAO. © 2011 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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| 40. |
- Macassa, Gloria, et al.
(author)
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Employment status and health care utilization in a context of economic recession : Results of a population based survey in East Central Sweden
- 2014
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In: Science Journal of Public Health. - 2328-7942 .- 2328-7950. ; 2:6, s. 610-616
-
Journal article (peer-reviewed)abstract
- Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey “Health in Equal Terms” carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.
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| 41. |
- Macassa, Gloria, et al.
(author)
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Psychological abuse among older persons in Europe : A cross-sectional study
- 2013
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In: Journal of Aggression, Conflict and Peace Research. - : Emerald. - 1759-6599. ; 5:1, s. 16-34
-
Journal article (peer-reviewed)abstract
- Purpose – Elder abuse is an issue of great concern world-wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period.Design/methodology/approach – The study design was cross-sectional and data were collected during January-July 2009 in the survey “Elder abuse: a multinational prevalence survey, ABUEL”. The participants were 4,467 randomly selected persons aged 60-84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60-84 years (albeit representative and proportional to sex-age). The participants answered a structured questionnaire either through a face-to-face interview or a mix of interview/self-response. The data were analysed using descriptive statistics and regression methods.Findings – The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse.Social implications – Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse.Originality/value – The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse.
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| 42. |
- Macassa, Gloria, et al.
(author)
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Socioeconomic Position and Suicidal Ideation : Going Beyond Education, Occupation and Income
- 2016
-
Other publication (other academic/artistic)abstract
- Objective: Suicidal ideation have been found to be a strong predictor of suicide attempt as well as completed suicide. Currently, there is an on-going debate on the impact of the recent economic recession on mental health outcomes, including suicide behaviours. Northern Sweden continues to bear the consequences of the recent recession which started in 2008.Thus, this study investigates differentials in twelve months suicidal ideation by socio-economic position (SEP) among economically active persons residing in Västernorland County. In addition, the study discusses the importance of employment status as a fourth measure of socio-economic position in the context of economic hardship. Method: The study uses cross-sectional data from the 2010 Västernorrland in 2010 “Health on Equal Terms Survey”, which consisted of 5,050 in economically active persons aged 16-65 years. Descriptive and weighted regression analyses were performed and results are presented as OR´s (with 95% confidence intervals).Results: Suicidal ideation was statistically significantly associated with SEP as measured by education, occupation, income and employment status. Respondents who had primary education, were manual workers, or had lower income and were out of work had odds ratios of 2.19 (CI 1.51-3.16); 2.95 (CI 2.04-4.27); 3.40 (CI 2.41-4.79) and 3.24 (CI 2.84-4.21), respectively. Controlling for demographic, socio-economic and health-related variables only eliminated the statistical significance for education and income.Conclusion: SEP as measured by education, occupation, income and employment was associated with suicide ideation in Västernorrland County. Also, employment status was found to be an important measure of SEP within the context of economic recession. There is a need for social protective policies for the less privileged in the population at all times, but especially during times of economic crises.
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| 43. |
- Melchiorre, Maria Gabriella, et al.
(author)
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Abuse of older men in seven European countries : a multilevel approach in the framework of an ecological model
- 2016
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.METHODS: The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.RESULTS: Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused.CONCLUSIONS: Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.
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| 44. |
- Melchiorre, Maria Gabriella, et al.
(author)
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The prevalence, severity and chronicity of abuse towards older men : Insights from a multinational European survey
- 2021
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In: PLOS ONE. - : PLoS. - 1932-6203. ; 16:4
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Journal article (peer-reviewed)abstract
- BACKGROUND: Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse.METHODS: Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months.RESULTS: Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high.CONCLUSIONS: Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.
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| 45. |
- Soares, Joaquim F J, et al.
(author)
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Psychosocial experiences among female and male primary care patients with and without pain
- 2007
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In: Pain clinic (Print). - 0169-1112 .- 1568-5691. ; 19:2, s. 58-70
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Journal article (peer-reviewed)abstract
- Objective: The study examined the psychosocial characteristics and experiences of female and male primary care patients with and without pain with particular interest in gender differences and whether females were more vulnerable to pain than males.Patients and methods: A total of 1122 primary care patients from 20 randomly selected primary care centres in Stockholm were assessed cross-sectionally on various variables during 15 consecutive days. The data were examined with chi-square tests, ANOVAs, Dunn?Bonferroni tests and multivariate logistic/linear regression analyses.Results: Pain patients compared to pain-free patients reported more depression, burn-out, job demands, less job control, more job strain, and financial problems, with no gender differences in general. These constructs were associated with pain in the regressions and some of them were inter-related. Factors such as sick-leave were also important. Female pain patients had a more severe clinical profile (e.g. pain intensity) than male patients. Female gender was a 'risk' factor for pain and for pain intensity/complexity, but other factors (e.g. sick-leave) were also important. In other areas (e.g. diagnoses), there were no gender differences. Missing data from the non-participant control group may have resulted in cases and controls that were not well matched. This may have weakened the strength of the comparisons between patient groups. Nevertheless, the results derive from a large clinical sample and are noteworthy.Conclusions: Pain patients did less well psychosocially and had received many traditional treatments for their pain without good effects. Interventions should be attentive to this and approaches such as cognitive-behaviour therapy used more often. Variables such as sick-leave and financial difficulties were associated with psychological and pain problems, and female gender was a 'risk' factor for pain and for pain intensity and complexity (multiple types of pain). Interventions should consider psychosocial factors and problems experienced particularly by women. The results confirmed previous findings from other studies and may have provided new insights into the experiences of female and male primary care patients with and without pain.
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| 46. |
- Soares, Joaquim J F
(author)
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Abuse against older persons
- 2015
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In: Journal of Nursing & Care. - USA : OMIC. - 2167-1168. ; 4:4
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Journal article (peer-reviewed)abstract
- Older age is often connected with stresses (e.g. reduced financial capacity, aloneness, increased morbidity). Violence may be an additional strain increasing the overall burden of older persons. Recent data with different samples (e.g. general population) concerning abuse towards older persons show prevalence rates up to 55%. Elder abuse co-exists for instance with depression, premature mortality and injury. Interestingly, little attention has been paid to sex differences in elder abuse. To the extent that such data exist, the findings are inconsistent, i.e. no differences between the sexes, women more abused than men and the opposite. Based on a randomly selected sample of 4,467 women and men aged 60-84 years from 7 European countries (Germany; Greece; Italy; Lithuania; Portugal; Spain; Sweden) and with well-known instruments (e.g. CTS2), we found the following. There were no differences between women and men concerning the prevalence of abuse (e.g. psychological), and its chronicity (how often) and severity (e.g. minor). However, when abuse acts were divided into low and high frequency, women tended to have been exposed to higher levels of abuse (e.g. psychological) than men. Furthermore, although abused women and men were doing worse (e.g. poor quality of life) than non-abused, women´s problems were more evident. Practitioners should consider these issues and develop effective prevention and treatment interventions to alleviate the situation of older persons.
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| 47. |
- Soares, Joaquim J. F., et al.
(author)
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Age and muscousceletal pain
- 2003
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In: International Journal of Behavioral Medicine. - 1070-5503 .- 1532-7558. ; 10:2, s. 181-190
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Journal article (peer-reviewed)abstract
- Using questionnaires, we analyzed associations between different pain variables (e.g., pain intensity) and age (20-65+ years) among 949 primary pain patients. Older patients (a) were more often divorced, were blue-collar workers, were less educated, and had greater difficulties with living expenses; (b) had pain of longer duration, more frequently and of more complexity, and felt more disabled; (c) consumed more painkillers, analgesics, sedatives, and other medications, and had received more pain treatments; and (d) had more health problems. Younger patients had more severe pain, were financially strained, and were more often unemployed. A multivariate regression analysis showed that high disability was more determined by older than young age. However, other factors (e.g., pain complexity) were also important. Thus, older and younger patients experienced their pain differently.
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| 48. |
- Soares, Joaquim J.F, et al.
(author)
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Men´s experiences of violence : extent, nature and ‘determinants’
- 2007
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In: International Journal of Social Welfare. - 1369-6866 .- 1468-2397. ; 16:3, s. 269-277
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Journal article (peer-reviewed)abstract
- We examined the extent, nature and 'determinants' of violence in a randomly selected sample of men from the general population (18-64 years, n = 520). The men were assessed on various factors (e.g. demographics). The design was cross-sectional and data were collected over eight consecutive weeks. About 68 per cent of the men reported experiencing violence at some point during their lifetime, and just over 14 per cent in the past 12 months. The violence occurred mainly in public and work settings, with threatening/aggressive language/physical assaults as the most common forms. The main perpetrators were strangers or clients. Sexual abuse was rare. Repeated/multiple abuses were common and injuries were sustained. The victims and non-victims were similar for many factors (e.g. alcohol use). Only younger age and being a blue-collar/low white-collar worker were risk factors for violence. Men's experiences of violence (e.g. physical assaults/multiple abuses) should be a source of concern as they can have profound negative effects. Extensive research on the impact of violence on men's health appears necessary in light of the present findings.
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| 49. |
- Soares, Joaquim J.F, et al.
(author)
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Quality of life among lifetime victimized men.
- 2007
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In: Violence and Victims. - : Springer Publishing Company. - 0886-6708 .- 1945-7073. ; 22:2, s. 289-204
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Journal article (peer-reviewed)abstract
- Quality of life was compared for lifetime victimized (n = 353) and nonvictimized men (n = 167) for demographic and quality of life variables by a cross-sectional design. The univariate analyses showed that victims compared to nonvictims had a lower quality of life, were younger, more often had upper secondary school education, and were more often blue-collar/low white-collar workers, on student allowances, on unemployment, financially strained, and smokers. The regressions revealed that unemployment, financial strain, smoking, depression, and home/public abuse were associated with reduced quality of life among victimized men. Being a blue-collar/low/intermediate white-collar worker and social support were related to increased quality of life. This study may have provided new insights into the experiences of quality of life of victimized men.
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| 50. |
- Soares, Joaquim J. F., 1947-, et al.
(author)
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Quality of life among persons aged 60-84 years in Europe: The role of psychological abuse and socio-demographic, social and health factors
- 2013
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In: Journal of Biosafety and Health Education. - : OMICS Publishing Group. - 2332-0893. ; 1:1, s. 1-12
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Journal article (peer-reviewed)abstract
- Background: Elder abuse and its effects are a serious public health issue. However, little is known about therelation between psychological abuse, other factors (e.g. social support) and quality of life (QoL) by domain. This studyaddressed differences in QoL by domain between psychologically abused and non-abused. While considering otherfactors such as social support.Methods: The respondents were 4,467 (2,559 women) randomly selected persons aged 60-84 years living in7 European cities. The mean response across countries was 45.2%. The cross-sectional data were analyzed withbivariate/multivariate methods.Results: Abused respondents contrasted to non-abused scored lower in QoL (autonomy, 67.42 ± 21.26 vs. 72.39± 19.58; intimacy, 55.31 ± 31.15 vs. 67.21 ± 28.55; past/present/future activities, 62.79 ± 19.62 vs. 68.05 ± 18.09;social participation, 65.03 ± 19.84 vs. 68.21 ± 19.77). Regressions showed that abuse was negatively associated withautonomy, intimacy and past/present/future activities, and positively with the social participation. All QoL dimensionswere negatively associated with country and depressive/anxiety symptoms, and positively with social support. Further,variables such as age, sex and somatic symptoms were negatively associated with some of the QoL dimensions andothers such as family structure, education, health care use and drinking positively. The regression model “explained”32.8% of the variation in autonomy, 45.6% in intimacy, 44.8% in past/present/future activities and 41.5% in socialparticipation.Conclusions: Abuse was linked to lower QoL in most domains, but other factors such as depressive symptomsalso carried a negative impact. Social support and to some extent family structure had a “protective” effect on QoL.Abuse, health indicators (e.g. depressive symptoms) and social support should be considered in addressing the QoL ofolder persons. However, QoL was influenced by many factors, which could not be firmly disentangled due to the crosssectionalapproach, calling for longitudinal research to address causality.
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