| 1. |
- 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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| 2. |
- Almquist, Ylva
(författare)
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Peer status in school and adult disease risk : A 30-year follow-up study of disease-specific morbidity in a Stockholm cohort
- 2009
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 63:12, s. 1028-1034
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Tidskriftsartikel (refereegranskat)abstract
- Background: Children have a social status position of their own, apart from that of the family, that may have an impact on short-term and long-term health. The aim of the present study was to analyse the associations between childhood social status in school (ie, peer status) and disease-specific morbidity in adulthood. Methods: Data were derived from a longitudinal study using a 1953 cohort born in Stockholm, Sweden: The Stockholm Birth Cohort Study (1953–2003). Peer status was sociometrically assessed in sixth grade (1966). Hazard ratios for adult disease-specific morbidity based on information on inpatient care (1973–2003) were calculated by peer status category for men and women separately, using Cox regression. Results: The results indicate that the lower the childhood peer status, the higher the overall adult disease risk. There were, however, differences in the degree and magnitude to which disease-specific inpatient care varied with peer status. Some of the steepest gradients were found for mental and behavioural disorders (eg, alcohol abuse and drug dependence), external causes (eg, suicide) and various lifestyle-related diseases (eg, ischaemic heart disease and diabetes). The results were not explained by childhood social class. Conclusion: The present study underlines the importance of recognising children’s social position, apart from that of their family, for later health. Not only psychologically related diseases but also those related to behavioural risk factors demonstrate some of the largest relative differences by peer status, suggesting that health-related behaviour may be one important mechanism in the association between peer status and morbidity.
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| 3. |
- Bahmanyar, S., et al.
(författare)
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Risk of suicide among operated and non-operated patients hospitalised for peptic ulcers
- 2009
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 63:12, s. 1016-1021
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Tidskriftsartikel (refereegranskat)abstract
- Background: Some small studies have reported high risk of suicide after surgical treatment for peptic ulcer. The aim of the present study was to explore the risk of suicide in hospitalised gastric ulcer and duodenal ulcer patients separately among operated and non-operated cohorts. Methods: Retrospective cohorts of 163 579 non-operated patients with gastric ulcer or duodenal ulcer and 28 112 patients with surgical treatment for ulcer, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation, or operation for the surgery cohort, until death, any cancer, emigration, or 31 December 2003. Standardised mortality ratios (SMRs) were calculated, and Poisson regression produced adjusted relative risk estimates among operated and non-operated patients. Results: Non-operated patients hospitalised for peptic ulcer showed a 70% excess risk of suicide (SMR 1.7, 95% CI 1.6 to 1.9) and those who underwent operation had a 60% increased risk (SMR 1.6, 95% CI 1.4 to 1.8). The risk of suicide was very high during the first year after hospitalisation (SMR 4.0, 95% CI 3.4 to 4.7) and more marked among women, patients under 70 and patients hospitalised without complications of ulcer. Both gastric ulcer and duodenal ulcer patients had high risk of suicide completion. Conclusion: Hospitalised patients with gastric ulcer or duodenal ulcer have an increased risk of suicide regardless of surgical treatment. These patients, especially women, are at very high risk during the first year after first hospitalisation/operation. The evaluation and management of suicidal thoughts in patients in medical settings should be further considered.
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| 4. |
- Bergström, Martin, et al.
(författare)
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Do different scales measure the same construct? Three Sense of Coherence scales.
- 2009
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 63:2, s. 166-167
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Tidskriftsartikel (refereegranskat)abstract
- Background: Different scales claim to measure the construct ‘‘Sense of Coherence’’. Results from these scales have been compared without knowing whether they measure the same construct. This article compares two versions of Antonovsky’s original scale (SOC-13 and SOC-29), translated into Swedish, and a three-item scale (SOC-3) that claims to measure Sense of Coherence. Methods: The data were analysed in a cross-sectional setting. The study consisted of university students studying social work (n=395. Results: The original scales had no distribution problems in differentiating Sense of Coherence. The SOC-3 had severe distribution problems. The two versions of the original Sense of Coherence scale had an acceptable reliability (Cronbach’s a; SOC-29=0.93, SOC-13=0.89). The SOC-3 scale did not have an acceptable reliability (Cronbach’s a=0.39). SOC-29 and SOC-13 had a high intercorrelation (r=0.96, p,0.001). The SOC-3 significantly correlated with SOC-29 (r=20.72, p,0.001) and SOC-13 (r=20.67, p,0.001), but the magnitude was significantly lower than the intercorrelation between SOC- 29 and SOC-13 (Fisher’s z-transformation, p,0.001. Conclusions: Because scales that claim to measure the same construct are not always interchangeable, researchers should make sure they compare results from studies that use the same scales.
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| 5. |
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| 6. |
- Björk, Jonas, et al.
(författare)
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Recreational values of the natural environment in relation to neighbourhood satisfaction, physical activity, obesity and wellbeing.
- 2008
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 62:4, s. 2-2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this population-based study was to investigate associations between recreational values of the close natural environment and neighbourhood satisfaction, physical activity, obesity and wellbeing. METHODS: Data from a large public health survey distributed as a mailed questionnaire in suburban and rural areas of southern Sweden were used (N = 24,819; 59% participation rate). Geocoded residential addresses and the geographical information system technique were used to assess objectively five recreational values of the close natural environment: serene, wild, lush, spacious and culture. RESULTS: On average, a citizen of the Scania region, inner city areas excluded, only had access to 0.67 recreational values within 300 metres distance from their residence. The number of recreational values near the residence was strongly associated with neighbourhood satisfaction and physical activity. The effect on satisfaction was especially marked among tenants and the presence of recreational values was associated with low or normal body mass index in this group. A less marked positive association with vitality among women was observed. No evident effect on self-rated health was detectable. CONCLUSIONS: Immediate access to natural environments with high recreational values was rare in the study population and was distributed in an inequitable manner. Moreover, such access was associated with a positive assessment of neighbourhood satisfaction and time spent on physical activity, which can be expected to reduce obesity and increase vitality by having a buffering effect on stress.
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| 7. |
- Canvin, Krysia, et al.
(författare)
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Can I risk using public services? Perceived consequences of seeking help and health care among households living in poverty: qualitative study
- 2007
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 61:11, s. 984-989
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To improve understanding of how families living in adverse conditions perceive their encounters with public services and how past experiences influence current and future attempts to seek help.Design: Qualitative interviews with adult members of households living in poverty in deprived areas, plus observations conducted in the surrounding neighbourhoods and service settings.Participants: Purposive sample of 25 adults living in a deprived area, on welfare benefits.Setting: Eight sites in disadvantaged areas in Merseyside, North Wales, London and Greater Manchester in 2004/05.Results: Participants generally perceived public services as a source of distrust and a potential risk to well-being. Encounters with a range of services were perceived as risky in terms of losing resources, being misunderstood or harshly judged, and carrying the ultimate threat of losing custody of their children. Participants perceived that they were subjected to increasing levels of surveillance, with fear of “being told on” by neighbours, in addition to service providers, adding to anxiety. Adverse consequences included avoiding child health and social services, anxiety and self-imposed isolation.Conclusions: Approaching services was perceived as akin to taking a gamble that might or might not result in their needs being met. Faced with this “choice”, participants employed strategies to minimise the risks that on the surface may appear risky to health. If public services are to succeed in providing support to disadvantaged families, greater efforts are needed to build trust and demonstrate understanding for the strategies these families use to maintain their well-being against formidable odds.
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| 8. |
- Carlson, Per
(författare)
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Relatively poor, absolutely ill? : A study of regional income inequality in Russia and its possible health consequences
- 2005
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 59:5, s. 389-394
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: To investigate whether the income distribution in a Russian region has a "contextual" effect on individuals' self rated health, and whether the regional income distributions are related to regional health differences. Methods: The Russia longitudinal monitoring survey (RLMS) is a survey (n = 7696) that is representative of the Russian population. With multilevel regressions both individual as well as contextual effects on self rated health were estimated. Main results: The effect of income inequality is not negative on men's self rated health as long as the level of inequality is not very great. When inequality levels are high, however, there is a tendency for men's health to be negatively affected. Regional health differences among men are in part explained by regional income differences. On the other hand, women do not seem to be affected in the same way, and individual characteristics like age and educational level seem to be more important. Conclusions: It seems that a rise in income inequality has no negative effect on men's self rated health as long as the level of inequality is not very great. On the other hand, when inequality levels are higher a rise tends to affect men's health negatively. A curvilinear relation between self rated health and income distribution is an interesting hypothesis. It could help to explain the confusing results that arise when you look at countries with a high degree of income inequality (USA) and those with lower income inequality (for example, Japan and New Zealand).
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| 9. |
- Chaix, Basile, et al.
(författare)
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Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort
- 2007
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 61:4, s. 349-355
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Tidskriftsartikel (refereegranskat)abstract
- Background: In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. Objective: To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differing population densities. Design: Multilevel survival analysis of a 28-year longitudinal database. Participants: 341 048 residents of the Scania region in Sweden, reaching age 50-79 years in 1996, followed up over 7 years. Results: After adjustment for several individual socioeconomic indicators over the adult age, Cox multilevel models indicated geographical variations in IHD mortality and socioeconomic contextual effects on the mortality risk. However, the magnitude of geographical variations and strength of contextual effects were modified by the age of individuals and the population density of their residential area: socioeconomic contextual effects were much stronger among non-elderly than among elderly adults, and much larger within urban territories than within rural ones. As a consequence, among non-elderly residents of urban territories, the socioeconomic contextual effect was almost as large as the effect of individual 20-year cumulated income. Conclusions: Non-elderly residents of deprived urban neighbourhoods constitute a major target for both contextual epidemiology of coronary disease and public health interventions aimed at reducing the detrimental effects of the social environment on IHD.
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| 10. |
- Chaix, Basile, et al.
(författare)
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Children's exposure to nitrogen dioxide in Sweden: investigating environmental injustice in an egalitarian country.
- 2006
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 60:3, s. 234-241
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: Prior studies have shown that children are particularly sensitive to air pollution. This study examined whether children of low socioeconomic status suffered greater exposure to outdoor nitrogen dioxide than more affluent ones, both at their place of residence and at school, in a country with widespread state intervention for social equity. Design: Local scale data on outdoor nitrogen dioxide obtained from a validated air pollution model were analysed, along with all school children accurately geocoded to their building of residence and school. Participants: All 29 133 children in grades one through nine (aged 7 to 15 years) residing and attending school in Malmo, Sweden, in 2001. Main results: Defining the socioeconomic status of children according to the mean income in their residential building, the spatial scan statistic technique allowed the authors to identify eight statistically significant clusters of low socioeconomic status children, all of which were located in the most polluted areas of Malmo. Four clusters of high socioeconomic status children were found, all of them located in the least polluted areas. The neighbourhood socioeconomic status better predicted the nitrogen dioxide exposure of children than the socioeconomic status of their building of residence. Exposure to nitrogen dioxide at the place of residence and school of attendance regularly increased as the socioeconomic status of a child's neighbourhood of residence decreased. Conclusions: Evidence of environmental injustice was found, even in a country noted for its egalitarian welfare state. Enforcement of environmental regulations may be necessary to achieve a higher level of environmental equity.
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