| 1. |
- Ahnquist, Johanna, et al.
(författare)
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Institutional trust and alcohol consumption in Sweden: The Swedish National Public Health Survey 2006
- 2008
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Trust as a measure of social capital has been documented to be associated with health. Mediating factors for this association are not well investigated. Harmful alcohol consumption is believed to be one of the mediating factors. We hypothesized that low social capital defined as low institutional trust is associated with harmful alcohol consumption. Methods: Data from the 2006 Swedish National Survey of Public Health were used for analyses. The total study population comprised a randomly selected representative sample of 26.305 men and 30.584 women aged 16-84 years. Harmful alcohol consumption was measured using a short version the Alcohol Use Disorders Identification Test (AUDIT), developed and recommended by the World Health Organisation. Low institutional trust was defined based on trust in ten main welfare institutions in Sweden. Results: Independent of age, country of birth and socioeconomic circumstances, low institutional trust was associated with increased likelihood of harmful alcohol consumption (OR (men) = 1.52, 95% CI 1.34-1.70) and (OR (women) = 1.50, 95% CI 1.35-1.66). This association was marginally altered after adjustment for interpersonal trust. Conclusion: Findings of the present study show that lack of trust in institutions is associated with increased likelihood of harmful alcohol consumption. We hope that findings in the present study will inspire similar studies in other contexts and contribute to more knowledge on the association between institutional trust and lifestyle patterns. This evidence may contribute to policies and strategies related to alcohol consumption.
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| 2. |
- Ahnquist, Johanna, et al.
(författare)
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Is cumulative exposure to economic hardships more hazardous to women's health than men's? : A 16-year follow-up study of the Swedish Survey of Living Conditions
- 2007
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Ingår i: Journal of Epidemiology and Community Health. - Swedish Natl Inst Publ Hlth, SE-10352 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. Swedish Natl Board Hlth & Welf, Stockholm, Sweden. : BMJ PUBLISHING GROUP. - 0143-005X .- 1470-2738. ; 61:4, s. 331-336
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown an association between cumulative economic hardships and various health outcomes. However, the cumulative effects of economic hardships in regard to gender differences have not been given enough attention. Methods: 1981 women and 1799 men were followed up over a period of 16 years (1981-1997), using data from the Swedish Survey of Living Conditions panel study. The temporal association between economic hardships and self-rated health, psychological distress and musculoskeletal disorders was analysed. Results: A dose-response effect on women's health was observed with increasing scores of cumulative exposure to financial stress but not with low income. Women exposed to financial stress at both T-1 and T-2 had an increased risk of 1.4-1.6 for all health measures compared with those who were not exposed. A similar consistent dose-response effect was not observed among men. Conclusions: There is a temporal relationship between cumulative economic hardships and health outcomes, and health effects differ by gender. Financial stress seems to be a stronger predictor of poor health outcomes than low income, particularly among women. Policies geared towards reducing health inequalities should recognise that long-term exposure to economic hardships damages health, and actions need to be taken with a gender perspective.
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| 3. |
- Al-Khalili, F, et al.
(författare)
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Clinical importance of risk factors and exercise testing for prediction of significant coronary artery stenosis in women recovering from unstable coronary artery disease : The Stockholm Female Coronary Risk Study
- 2000
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Ingår i: American Heart Journal. - Karolinska Hosp & Inst, Dept Cardiol, Stockholm, Sweden. Karolinska Hosp & Inst, Dept Thorac Radiol, Stockholm, Sweden. Karolinska Hosp & Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 139:6, s. 971-978
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Tidskriftsartikel (refereegranskat)abstract
- Background The objectives of this study were to investigate the relation between coronary risk factors, exercise testing parameters, and the presence of angiographically significant coronary artery disease (CAD) (>50% luminal stenosis) in female patients previously hospitalized for an acute CAD event. Methods and Results All women younger than age 66 years in the greater Stockholm area in Sweden who were hospitalized for acute coronary syndromes during a 3-year period were recruited, Besides collection of clinical parameters, coronary angiography and a symptom-limited exercise test were performed in 228 patients 3 to 6 months after the index hospitalization. The mean age was 56 +/- 7 years. Angiographically nonsignificant CAD (stenosis <50%) was verified in 37% of the patients; significant CAD was found in 63%. The clinical parameters that showed the strongest relation with the presence of significant CAD after adjusting for age were history of myocardial infarction (odds ratio [OR] 4.91, 95% confidence interval [CI] 2.35 to 7.49), history of diabetes mellitus (OR 3.83, 95% Cl 1.63 to 14.31), serum high-density lipoprotein cholesterol <1.4 mmol/L (OR 2.11, 95% Cl 1.20 to 3.72), and waist-to-hip ratio >0.85 (OR 1.78, 95% Cl 1.02 to 3.10). A low exercise capacity and associated low change of rate-pressure product from rest to peak exercise were the only exercise testing parameters that were significantly related to angiographically verified significant CAD (<90% of the predicted maximal work capacity adjusted for age and weight, OR 1.91, 95% CI 1.04 to 3.50). Conclusions In female patients recovering from unstable CAD, exercise capacity was the only exercise testing parameter of value in the prediction of significant CAD. The consideration of certain clinical characteristics and coronary risk factors offer better or complementary information when deciding on further coronary assessment.
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| 4. |
- Al-Khalili, F, et al.
(författare)
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Clinical predictors of poor outcome in women recovering from acute coronary syndrome
- 2000
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Ingår i: Journal of the American College of Cardiology. - Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Publ Hlth Sci, Div Prevent Med, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Thorac Radiol, S-10401 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. : ELSEVIER SCIENCE INC. - 0735-1097 .- 1558-3597. ; 35:2, s. 392A-392A
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Al-Khalili, F, et al.
(författare)
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Prognostic value of exercise testing in women after acute coronary syndromes (The Stockholm Female Coronary Risk Study)
- 2000
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Ingår i: American Journal of Cardiology. - Karolinska Hosp, Dept Cardiol, S-17176 Stockholm, Sweden. Karolinska Hosp, Dept Publ Hlth Sci, Div Prevent Med, S-17176 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. : EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. - 0002-9149 .- 1879-1913. ; 86:2, s. 211-213
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Tidskriftsartikel (refereegranskat)
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| 6. |
- Balog, P, et al.
(författare)
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Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Coronary Risk Study
- 2003
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Ingår i: Journal of Psychosomatic Research. - Swedish Natl Inst Publ Hlth, Stockholm, Sweden. Karolinska Inst, Dept Publ Hlth & Sci, Stockholm, Sweden. Semmelweis Univ, Dept Behav Sci, H-1085 Budapest, Hungary. : PERGAMON-ELSEVIER SCIENCE LTD. - 0022-3999 .- 1879-1360. ; 54:2, s. 113-119
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to investigate the effect of marital and job stress on depressive symptoms in middle aged women with coronary heart disease (CHD) and healthy women who were cohabiting and currently working. Method: Data were obtained from the Stockholm Female Coronary Risk (FemCorRisk) Study, a population-based case-control study, comprising all women aged 65 years or younger who were admitted for an acute event of CHD between 1991 and 1994. For each patient, an age-matched healthy control was recruited. Marital stress was assessed by a structured interview developed in our research laboratory and work stress by the Karasek demand-control questionnaire. Depressive symptoms were measured by a questionnaire derived from Pearlin et al. [J. Health Soc. Behav. 22 (1981) 337], which was validated by the Beck Depression Inventory. Results: Depressive symptoms were twice as common in women with as in women without coronary disease: Marital stress was statistically significantly associated with depressive symptoms, even after controlling for age, educational level, menopausal status, body mass index (BMI), sedentary lifestyle, cigarette smoking and severity of heart failure symptoms. In both groups, depressive symptoms increased with increasing exposure to marital stress in a graded fashion. Work stress was not associated with depressive symptoms after multivariate adjustment. Conclusions: Marital stress but not work stress is independently related to depressive symptoms in women. Women with coronary disease react similarly to marital stress as healthy women, but depart from a higher level of depression, which may. be explained by their poorer health status. (C) 2003 Elsevier Science Inc. All rights reserved.
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| 7. |
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| 8. |
- Blom, M, et al.
(författare)
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Social relations in women with coronary heart disease : the effects of work and marital stress
- 2003
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Ingår i: Journal of Cardiovascular Risk. - Karolinska Hosp, Karolinska Inst, Dept Publ Hlth Sci, S-17176 Stockholm, Sweden. Semmelweis Univ, Inst Behav Sci, H-1085 Budapest, Hungary. Swedish Natl Inst Publ Hlth, Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1350-6277 .- 1473-5652. ; 10:3, s. 201-206
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Tidskriftsartikel (refereegranskat)abstract
- Background Studies have previously shown that psychosocial stress, related to both work and family, is associated with the increased risk of coronary heart disease (CHD) morbidity and mortality. The objective of this study was to examine how social relations are affected by marital stress and work stress in a population-based sample of Swedish women with CHD. Method Data was obtained from the Stockholm Female Coronary Risk Study, comprising 292 women aged 65 years or younger, with a mean age of 56 (SD = 7) years admitted for an acute event of CHD and examined 3-6 months after hospitalization. Marital and work stress was assessed using the Stockholm Marital Stress Scale and the Swedish version of the Karasek demand-control questionnaire, respectively. Condensed versions of the Interview Schedule for Social Interaction (ISSI) and of Interpersonal Support Evaluation List (ISEL) were used to assess social relations and social support. Results Marital stress was associated with less social integration (P< 0.001), less appraisal support (P< 0.001), a lower sense of belonging (P<0.01) and less tangible support (P< 0.01) even after controlling for work stress. Adjustment for age, socioeconomic status (education and occupational status) did not alter these results significantly. Work stress did not show statistically significant effects on any of the measured social relations. Conclusion The present study showed that marital stress influenced women's social relations. These results suggest that marital stress needs to be further investigated not only as an independent but also as an interactive risk factor for women with CHD. J Cardiovasc Risk 10:201-206 (C) 2003 Lippincott Williams Wilkins.
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| 9. |
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| 10. |
- Danielson, J, et al.
(författare)
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Vital exhaustion in relation to lipid profile in healthy women
- 2001
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Ingår i: Psychosomatic Medicine. - Karolinska Inst, Div Prevent Med, Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 0033-3174 .- 1534-7796. ; 63:1, s. 106-107
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Horsten, M, et al.
(författare)
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Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women - The Stockholm Female Coronary Risk Study
- 2000
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Ingår i: European Heart Journal. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : W B SAUNDERS CO LTD. - 0195-668X .- 1522-9645. ; 21:13, s. 1072-1080
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Tidskriftsartikel (refereegranskat)abstract
- Aims Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However. little is known; about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study. Methods and Results Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events. including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event. symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms. the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1.9 (95% CI 1.02-3 6). Conclusions The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis. (C) 2000 The European Society of Cardiology.
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| 12. |
- Horsten, M, et al.
(författare)
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Depressive symptoms, social support, and lipid profile in healthy middle-aged women
- 1997
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Ingår i: Psychosomatic Medicine. - KAROLINSKA INST, DEPT PUBL HLTH SCI, DIV PREVENT MED, S-14157 HUDDINGE, SWEDEN. TILBURG UNIV, DEPT PSYCHOL, NL-5000 LE TILBURG, NETHERLANDS. : LIPPINCOTT WILLIAMS & WILKINS. - 0033-3174 .- 1534-7796. ; 59:5, s. 521-528
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Several studies have reported an inverse relationship between cholesterol levels and death from violent causes, including suicide. Because depression and depressive symptoms are associated with suicide and trauma, the relation between cholesterol and depressive symptoms is of interest. The objective of the present study was to examine this relationship in a group of healthy women. The second main objective of the study was to investigate the association between cholesterol and other psychosocial factors (social support, Vital exhaustion, and stressful life-events), which are known to be related to depression. Method: The study group consisted of 300 healthy women raged 31 to 65 years who were representative of women living in the greater Stockholm area. Depressive symptoms were measured by a nine-item questionnaire derived from Pearlin. For the measurement of social support a modified version of the Interview Schedule for Social Interaction was used. Health behaviors were measured by means of standard questionnaires. Lipids were analyzed by enzymatic and immunoturbidometric methods. Results: Women with a low serum cholesterol, defined as the lowest tenth of the cholesterol distribution (less than or equal to 4.7 mmol/1), reported significantly more depressive symptoms. In addition, depressive symptoms showed a significant inverse linear association with high-density lipoprotein (HDL). In multivariate models, which adjusted for smoking, alcohol consumption, exercise habits, body-mass index, waist-hip ratio, menopausal status, age, and educational level, these associations remained significant. In addition, when analyzed in relation to other psychosocial factors, low cholesterol was found to be strongly associated with lack of social support. This association was not explained by depressive symptoms. Conclusions: Low cholesterol levels in middle-aged healthy Swedish women were associated with a higher prevalence of depressive symptoms and with lack of social support. These findings may constitute a possible mechanism for the association found between low cholesterol and increased mortality, particularly suicide.
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| 13. |
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| 14. |
- Horsten, M, et al.
(författare)
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Psychosocial factors and heart rate variability in healthy women.
- 1999
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Ingår i: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 61:1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women. METHODS: The study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed. RESULTS: Social isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results. CONCLUSIONS: These findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.
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| 15. |
- Horsten, M, et al.
(författare)
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Social relations and the metabolic syndrome in middle-aged Swedish women
- 1999
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Ingår i: Journal of Cardiovascular Risk. - Karolinska Inst, Novum, Div Prevent Med, Dept Publ Hlth Sci, S-14157 Huddinge, Sweden. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1350-6277 .- 1473-5652 .- 1741-8267 .- 1741-8275. ; 6:6, s. 391-397
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Tidskriftsartikel (refereegranskat)abstract
- Background Both social isolation and the metabolic syndrome are independently associated with greater than normal cardiovascular risk. Design A population-based cross-sectional study of middle-aged Swedish women. Methods The study group consisted of 300 healthy women (aged 31-65 years) who were representative of women living in the greater Stockholm area. Social isolation was measured by using a condensed Version of the Interpersonal Support Evaluation List. Health behaviours were assessed and a full serum-lipid-level and haemostatic profile was obtained by standardized methods, The metabolic syndrome was defined as the presence of two or more of these components: fasting serum level of glucose greater than or equal to 7.0 mmol/l, arterial blood pressure greater than or equal to 160/90 mmHg, fasting serum level of triglycerides greater than or equal to 1.7 mmol/l or high-density lipoprotein < 1.0 mmol/l, or both, and central obesity (waist:hip ratio > 0.85 or body mass index > 30 kg/m(2), or both), Results After adjustment for age, menopausal status, educational level, smoking, exercise habits and consumption of alcohol, the risk ratio for the metabolic syndrome for women in the lower compared with women in the upper social-support quartile was 3.5 (95% confidence interval 1.1-11.4), whereas that of women in the two middle quartiles was 2.2 (95% confidence interval 0.67-7.2; P for trend 0.02). Conclusions Social isolation was associated with the metabolic syndrome for these middle-aged women. The findings suggest that the metabolic syndrome and its components may be mediators of the reported association between social isolation and cardiovascular disease, (C) 1999 Lippincott Williams & Wilkins.
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| 16. |
- Koertge, J C, et al.
(författare)
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Vital exhaustion in relation to lifestyle and lipid profile in healthy women
- 2003
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Ingår i: International Journal of Behavioral Medicine. - : LAWRENCE ERLBAUM ASSOC INC. - 1070-5503 .- 1532-7558. ; 10:1, s. 44-55
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Tidskriftsartikel (refereegranskat)abstract
- "Vital exhaustion," characterized by fatigue, irritability, and demoralization, precedes new and recurrent coronary events. Biological mechanisms explaining this association are not fully understood. The objective was to investigate the relationship between vital exhaustion, lifestyle, and lipid profile. Vital exhaustion, smoking, body mass index (BMI), alcohol consumption, exercise capacity, and serum lipids were determined in 300 healthy women, aged 56.4 +/- 7.1 years. No statistically significant associations were found between vital exhaustion and lifestyle variables. Divided into quartiles, vital exhaustion was inversely related to high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 in a linear fashion after adjustment for age, BMI, exercise capacity, and alcohol consumption. A multivariate-adjusted vital exhaustion-score in the top quartile, as compared to one in the lowest, was associated with 12% lower HDL-C and 8% lower apolipoprotein A1 (p < .05). In conclusion, alterations in lipid metabolism may be a possible mediating mechanism between vital exhaustion and coronary heart disease. The impact of lifestyle variables was weak.
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| 17. |
- Koertge, J., et al.
(författare)
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Vital exhaustion and recurrence of CHD in women with acute myocardial infarction
- 2002
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Ingår i: Psychology, Health & Medicine. - : Informa UK Limited. - 1354-8506 .- 1465-3966. ; 7:2, s. 117-126
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to investigate the prospective impact of vital exhaustion on recurrence after acute myocardial infarction (AMI) in women. Women ≤ 65 years, mean age = 55.30, SD = 7. 63, N = 110, consecutively admitted to a coronary care unit with AMI were examined after three-six months, and followed for five years. Vital exhaustion was assessed using an early version of the Maastricht Questionnaire. A recurrent event was defined as cardiac death, AMI or a revascularization procedure. Forty-five recurrent events were found (in 41% of the study group). One standard deviation (8.4 points) increase of vital exhaustion scores was associated with a 53 % increased risk of a new event and a score above the median was associated with a hazard ratio of 2.24 (95% CI 1.21-4.14). These results remained after adjusting severity of chest pain and significant coronary stenosis. In conclusion, it was found that vital exhaustion is a marker of poor prognosis in women with AMI. The relationship appears to be independent of signs of underlying disease, including severity of chest pain and significant coronary stenosis.
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| 18. |
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| 19. |
- Orth-Gomer, K, et al.
(författare)
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Social relations and extent and severity of coronary artery disease - The Stockholm Female Coronary Risk Study
- 1998
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Ingår i: European Heart Journal. - Karolinska Inst, Novum, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Boston, MA USA. Univ Texas, Sch Med, Div Cardiol, Houston, TX USA. Karolinska Hosp, Dept Thorac Med, S-10401 Stockholm, Sweden. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : W B SAUNDERS CO LTD. - 0195-668X .- 1522-9645. ; 19:11, s. 1648-1656
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Tidskriftsartikel (refereegranskat)abstract
- Aims Social relations have been repeatedly linked to coronary heart disease in men, even after careful control for standard risk factors. Women have rarely been studied and results have not been conclusive. We investigated the role of social support in the severity and extent of coronary artery disease in women. Methods and Results One hundred and thirty-one women, aged 30 to 65 years, who were hospitalized for an acute coronary event and were included in the Stockholm Female Coronary Risk Study, were examined with computer assisted quantitative coronary angiography. Angiographic measures included presence of stenosis greater than 50% in at least one coronary artery (severity) and the number of stenoses greater than 20% within the coronary tree (extent). Social factors included two measures of social support, which were previously shown to predict coronary disease in prospective studies of men. After adjustment for age, lack of social support was associated with both measures of coronary artery disease. With further adjustment for smoking, education, menopausal status, hypertension, high density lipoprotein and body mass index, the risk ratio for stenosis greater than 50% in women with poor as compared to those with strong social support was 2.5 (95% confidence interval 1.2 to 5.3; P=0.003). Also, women with poor social support had more stenoses obstructing at least 20% of the coronary lumen with multivariate adjustment, but the difference from women with strong support was only of borderline significance (P=0.09). Conclusion The findings suggest that lack of social support contributes to the severity of coronary artery disease in women, independent of standard risk factors.
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| 20. |
- Wamala, S.P, et al.
(författare)
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Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women
- 1997
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Ingår i: Preventive Medicine. - : Elsevier BV. - 0091-7435 .- 1096-0260. ; 26:5 I, s. 734-744
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Tidskriftsartikel (refereegranskat)abstract
- Background. It has been previously demonstrated that obesity is common among women with low socioeconomic status (SES), but the factors accounting for this association are not well known. According to our hypothesis, low SES is associated with psychosocial stress, an unhealthy lifestyle, and reproductive history, which may increase the likelihood of women with low SES to be overweight or obese. Methods. We examined overweight and obesity in relation to SES among 300 healthy women ages 30-65 years, who constitute the control group of the Stockholm Female Coronary Risk Study, a population- based case-control study of women with coronary heart disease. This control group was compared with a large population-based sample and found to be representative of healthy Swedish women ages 30-65 years. We used an aggregate of education and occupation as a measure of SES and defined overweight as body mass index (BMI) between 23.8 and 28.6 kg/m2 and obesity as BMI > 28.6 kg/m2. Results. Low SES was a strong determinant of overweight and obesity among middle-aged healthy Swedish women. The odds of being overweight or obese increased with lower social position. After adjustment for age, the odds ratios for overweight and obesity among women in a low vs high position were 2.2 [95% confidence interval (CI) 1.1 to 4.4) and 2.7 (95% CI 1.1 to 6.7), respectively. Both low social position and obesity were related to reproductive history (higher parity and earlier age at menarche), unhealthy dietary habits, and unfavorable psychosocial factors (poor quality of life, low self-esteem, and job strain). These factors together explained 53% of the low. SES-obesity association. Conclusions. Reproductive history, unhealthy dietary habits, and psychosocial stress accounted for a large part of the association between low SES and obesity. Dietary habits and psychosocial stress are potentially modifiable factors, which should be taken into account in intervention programs among women with low SES.
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| 21. |
- Wamala, S.P, et al.
(författare)
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Education and the metabolic syndrome in women
- 1999
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Ingår i: Diabetes Care. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, Stockholm, Sweden. Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 22:12, s. 1999-2003
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - The main objective was to examine the association between the metabolic syndrome and socioeconomic position las indicated by education) among women, RESEARCH DESIGN AND METHODS - The study sample comprised healthy women (aged 30-65 years) in Sweden who were representative of the general population in a metropolitan area. Socioeconomic position was measured by educational level (mandatory [less than or equal to 9 years], high school, or college/university). The metabolic syndrome was defined as the presence of two or mon: of the following components: 1) fasting plasma glucose level greater than or equal to 7.0 mmol/l; 2) arterial blood pressure greater than or equal to 160/90 mmHg; 3) fasting plasma triglycerides greater than or equal to 1.7 mmol/l and/or HDL cholesterol <1.0 mmol/l; and 4) central obesity (waist-to-hip ratio >0.85 and/or BMI >30 kg/m(2)), RESULTS - After adjustment for age, the risk ratio for the presence of the metabolic syndrome comparing the lowest (less than or equal to 9 years) with the highest (college/university) education was 2.7 (95% CI 1.1-6.8)1 This association persisted after controlling for menopausal status, family history of diabetes, and behavioral risk factors. CONCLUSIONS - Low education is associated with increased risk for metabolic syndrome in middle-aged women. These findings show that not only are women with low socioeconomic position at increased risk for individual risk factors that are associated with cardiovascular disease and type 2 diabetes, they are also at increased risk for the metabolic clustering of risk factors.
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| 22. |
- Wamala, S.P, et al.
(författare)
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Inequity in access to dental care services explains current socioeconomic disparities in oral health: The Swedish National Surveys of Public Health 2004-2005
- 2006
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Ingår i: Journal of Epidemiology and Community Health. - Natl Publ Hlth Inst, S-10352 Stockholm, Sweden. Lund Univ, Dept Clin Sci Malmo, Fac Med Publ Hlth & Community Med, Lund, Sweden. : BMJ. - 1470-2738 .- 0143-005X. ; 60:12, s. 1027-1033
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index ( SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. Participants: Swedish population-based sample of 17 362 men and 20 037 women. Results: Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7(95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8( 95% CI 6.2 to 7.5). The corresponding values among women were 2.3 ( 95% CI 2.1 to 2.5) and 6.8 ( 95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7 - 9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. Conclusions: Results call for urgent public health interventions to increase equitable access to dental care services.
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| 23. |
- Wamala, S.P, et al.
(författare)
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Job stress and the occupational gradient in coronary heart disease risk in women - The Stockholm Female Coronary Risk Study
- 2000
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Ingår i: Social Science and Medicine. - Karolinska Inst, Div Prevent Med, Dept Publ Hlth Sci, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA 02115 USA. Karolinska Hosp, Dept Cardiol, S-10401 Stockholm, Sweden. : PERGAMON-ELSEVIER SCIENCE LTD. - 0277-9536 .- 1873-5347. ; 51:4, s. 481-489
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD, Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk. (C) 2000 Elsevier Science Ltd. All rights reserved.
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| 24. |
- Wamala, S.P, et al.
(författare)
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Perceived discrimination and psychological distress in Sweden
- 2007
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Ingår i: British Journal of Psychiatry. - Natl Inst Publ Hlth, S-10352 Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. Swedish Assoc Local Author & Reg, Stockholm, Sweden. : CAMBRIDGE UNIV PRESS. - 0007-1250 .- 1472-1465. ; 190, s. 75-76
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Tidskriftsartikel (refereegranskat)abstract
- There is lack of evidence on the health effects of perceived discrimination.We analysed the association between perceived discrimination and psychological distress, and whether socio-economic disadvantage explains this association in 15 406 men and 17 922 women in Sweden during 2004. After adjustment for age and long-term illness, frequent experiences of discrimination were associated with increased likelihood of psychological distress. Socio-economic disadvantage explained about 25% of this association. Declaration of interest None.
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| 25. |
- Wamala, S.P, et al.
(författare)
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Short stature and prognosis of coronary heart disease in women
- 1999
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Ingår i: Journal of Internal Medicine. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Karolinska Hosp, Dept Cardiol, Stockholm, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Beth Israel Deaconess Med Ctr, Div Cardiovasc, Boston, MA USA. : WILEY. - 0954-6820 .- 1365-2796. ; 245:6, s. 557-563
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To investigate the effect of short stature on prognosis following an acute event of coronary heart disease (CHD) in women. Setting. All women who were hospitalized for an acute event of CHD in any of the 10 cardiology clinics in greater Stockholm were investigated for the first time in the Stockholm Female Coronary Risk Study between 1991 and 1994, and were followed until August 1997 for recurrent coronary events. Design. A follow-up study of women with either acute myocardial infarction (AMI) or unstable angina pectoris, Median follow-up period was 4.8 years. Subjects. A total of 292 Swedish women, aged 65 years or younger. Main outcome measures. Recurrent AMI, death from CHD or revascularization procedure (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Results. Independent of the confounding effects of other risk factors of clinical importance for CHD (age, socioeconomic status, menopausal status, index event, congestive heart failure, angina severity, diabetes, hypertension, smoking, triglycerides and HDL cholesterol), the shortest 25% of women (<160 cm) had a 2.1-fold (95% CI = 1.0-4.4) increased rate of developing adverse cardiac events (cardiovascular death, recurrent AMI or revascularization procedure) compared with the tallest 25% (>165 cm). In addition, an increased rate was observed for each 10 cm difference in height (hazard ratio = 1.7, 95% CI = 1.4-2.7). Similar results were observed when analysing each outcome separately. Conclusions. These data indicate that short stature is a strong predictor of poor prognosis after an acute coronary event in women, independent of socioeconomic status and other risk factors for CHD.
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| 26. |
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| 27. |
- Wamala, S. P, et al.
(författare)
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Socioeconomic status and determinants of hemostatic function in healthy women
- 1999
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-14157 Huddinge, Sweden. Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA. Karolinska Hosp, Dept Cariol, S-10401 Stockholm, Sweden. Karolinska Hosp, King Gustaf V Res Inst, Atherosclerosis Res Unit, S-10401 Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 1079-5642 .- 1524-4636. ; 19:3, s. 485-492
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Tidskriftsartikel (refereegranskat)abstract
- Hemostatic factors are reported to be associated with coronary heart disease (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemostatic profile, but the factors underlying this association are not well known. Our aim was to examine determinants of the socioeconomic differences in hemostatic profile. Between 1991 and 1994, we studied 300 healthy women, aged 30 to 65 years, who were representative of women living in the greater Stockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activated factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured. Educational attainment was used as a measure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial stress, atherogenic biochemical factors, and hypertension. Levels of hemostatic factors increased with lower educational attainment. Independently of age, the differences between the lowest (mandatory) and highest (college/university) education in FVII:Ag levels were 41 mu g/L (95% confidence interval [CI] 15 to 66 mu g/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.001) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were not statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patterns, biochemical factors, and hypertension, statistically significant differences between mandatory and college/university education were observed in FVII:Ag (difference=34 mu g/L; 95% CI, 2 to 65 mu g/L, P=0.05) but not in fibrinogen (difference 0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in VWF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An educational gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and VWF. Age, psychosocial stress, unhealthful life style, atherogenic biochemical factors, and hypertension mediated the association of low educational level with elevated levels of fibrinogen and vWF. Psychosocial stress and unhealthful life style were the most important contributing factors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.
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| 28. |
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| 29. |
- Wamala, S. P, et al.
(författare)
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Trends in absolute socioeconomic inequalities in mortality in Sweden and New Zealand. A 20-year gender perspective
- 2006
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Ingår i: BMC Public Health. - Swedish Natl Inst Publ Hlth, Stockholm, Sweden. Karolinska Inst, S-10401 Stockholm, Sweden. Wellington Sch Med, Dept Publ Hlth, Wellington, New Zealand. : BMC. - 1471-2458. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Both trends in socioeconomic inequalities in mortality, and cross-country comparisons, may give more information about the causes of health inequalities. We analysed trends in socioeconomic differentials by mortality from early 1980s to late 1990s, comparing Sweden with New Zealand. Methods: The New Zealand Census Mortality Study (NZCMS) consisting of over 2 million individuals and the Swedish Survey of Living Conditions (ULF) comprising over 100, 000 individuals were used for analyses. Education and household income were used as measures of socioeconomic position (SEP). The slope index of inequality (SII) was calculated to estimate absolute inequalities in mortality. Analyses were based on 3 - 5 year follow-up and limited to individuals aged 25 - 77 years. Age standardised mortality rates were calculated using the European population standard. Results: Absolute inequalities in mortality on average over the 1980s and 1990s for both men and women by education were similar in Sweden and New Zealand, but by income were greater in Sweden. Comparing trends in absolute inequalities over the 1980s and 1990s, men's absolute inequalities by education decreased by 66% in Sweden and by 17% in New Zealand ( p for trend < 0.01 in both countries). Women's absolute inequalities by education decreased by 19% in Sweden ( p = 0.03) and by 8% in New Zealand ( p = 0.53). Men's absolute inequalities by income decreased by 51% in Sweden ( p for trend = 0.06), but increased by 16% in New Zealand ( p = 0.13). Women's absolute inequalities by income increased in both countries: 12% in Sweden ( p = 0.03) and 21% in New Zealand ( p = 0.04). Conclusion: Trends in socioeconomic inequalities in mortality were clearly most favourable for men in Sweden. Trends also seemed to be more favourable for men than women in New Zealand. Assuming the trends in male inequalities in Sweden were not a statistical chance finding, it is not clear what the substantive reason(s) was for the pronounced decrease. Further gender comparisons are required.
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| 30. |
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| 31. |
- Wamala, S. P, et al.
(författare)
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Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk : the Stockholm Female Coronary Risk Study
- 2001
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Ingår i: International Journal of Epidemiology. - Karolinska Inst, Dept Publ Hlth Sci, Div Prevent Med, S-17176 Stockholm, Sweden. Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA. : OXFORD UNIV PRESS. - 0300-5771 .- 1464-3685. ; 30:2, s. 275-284
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Tidskriftsartikel (refereegranskat)abstract
- Background Measures of low socioeconomic position have been associated with increased risk for coronary heart disease (CHD) among women. A more complete understanding of this association is gained when socioeconomic position is conceptualized from a life course perspective where socioeconomic position is measured both in early and later life. We examined various life course socioeconomic indicators in relation to CHD risk among women. Methods The Stockholm Female Coronary Risk Study is a population-based case-control study, in which 292 women with CHD aged less than or equal to 65 years and 292 age-matched controls were investigated using a wide range of socioeconomic, behavioural, psychosocial and physiological risk factors. Socioeconomic disadvantage in early life (large family size in childhood, being born last, low education), and in later life (housewife or blue-collar occupation at labour force entry blue-collar occupation at examination, economic hardships prior to examination) was assessed. Results Exposure to early (OR = 2.65, 95% CI : 1.12-6.54) or later (OR = 5.38, 95% CI : 2.01-11.43) life socioeconomic disadvantage was associated with increased CHD risk as compared to not being exposed. After simultaneous adjustment for marital status and traditional CHD risk factors, early and later socioeconomic disadvantage, exposure to three instances of socioeconomic disadvantage in early life was associated with an increased CHD risk of 2.48 (95% CI:0.90-6.83) as compared to not being exposed to any disadvantage. The corresponding adjusted risk associated with exposure to later life disadvantage was 3.22 (95% CI : 1.02-10.53). Further analyses did not show statistical evidence of interaction effects between early and later life exposures (P = 0.12), although being exposed to both resulted in a 4.2-fold (95% CI: 1.4-12.1) increased CHD risk. Exposure to cumulative socioeconomic disadvantage (combining both early and later life), across all stages in the life course showed strong, graded associations with CHD risk after adjusting for traditional CHD risk factors. Stratification of cumulative disadvantage by body height showed that exposure to more than three periods of cumulative socioeconomic disadvantage had a 1.7- (95% CI : 0.9-3.2) and 1.9-(95% CI : 1.0-7.7) fold increased CHD risk for taller and shorter women, respectively. The combination of both short stature and more than two periods of cumulative socioeconomic disadvantage resulted in a 4.4-fold (95% CI : 1.7-9.3) increased CHD risk. Conclusions Both early and later exposure to socioeconomic disadvantage were associated with increased CHD risk in women. Later life exposure seems to be more harmful for women's cardiovascular health than early life exposure to socioeconomic disadvantage. However, being exposed to socioeconomic disadvantage in both early and later life magnified the risk for CHD in women. Cumulative exposure to socioeconomic disadvantage resulted in greater likelihood of CHD risk, even among women who were above median height. In terms of better understanding health inequalities among women, measures of socioeconomic disadvantage over the life course are both conceptually and empirically superior to using socioeconomic indicators from one point in time.
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| 32. |
- Weidner, G, et al.
(författare)
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Cardiovascular reactivity to mental stress in the Stockholm Female Coronary Risk Study
- 2001
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Ingår i: Psychosomatic Medicine. - SUNY Stony Brook, Dept Psychol, Stony Brook, NY 11794 USA. Univ Educ, Dept Hlth Psychol, Schwabisch Gmund, Germany. Karolinska Inst, Dept Prevent Med, Stockholm, Sweden. Karolinska Inst, Dept Cardiol, Stockholm, Sweden. Karolinska Hosp, S-10401 Stockholm, Sweden. Univ Stockholm, Student Hlth Ctr, Stockholm, Sweden. : LIPPINCOTT WILLIAMS & WILKINS. - 0033-3174 .- 1534-7796. ; 63:6, s. 917-924
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study evaluated the ability of mental stress testing to discriminate between women with and without CHD, and among women with different disease manifestations, taking into account history of hypertension and beta -blocker use. Methods: Analyses were based on data from a community-based case-control study of women aged 65 years or younger. The study group consisted of 292 women who were hospitalized for an acute event of CHD, either AMI or unstable AP in Stockholm between 1991 and 1994. Controls were matched to cases by age and catchment area. Cardiovascular reactivity and emotional response to an anagram task solved under time pressure were measured 3 to 6 months after hospitalization. Results: Patients reacted with smaller increases in heart rate (4 bpm) than their controls (7 bpm). Results for the rate-pressure product were similar. Cardiovascular reactions did not distinguish patients with AP from those with AML History of hypertension (present in 50% of patients and 11% of controls) was related to enhanced diastolic blood pressure reactivity. Patients on beta -blockers (66%) had lower heart-rate levels throughout testing, but did not differ in their cardiovascular stress reactions when compared with the remaining participants. Conclusions: Women with heart disease have somewhat lower heart-rate responses to stress than healthy age-matched controls. History of hypertension is related to enhanced diastolic blood pressure reactivity to mental stress in both patients and controls.
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