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| 4. |
- Blank, N, et al.
(författare)
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Short-term and long-term sick-leave in Sweden: relationships with social circumstances, working conditions and gender
- 1995
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Ingår i: Scandinavian journal of social medicine. - : SAGE Publications. - 0300-8037. ; 23:4, s. 265-272
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of the study was to analyse similarities and differences between repeated spells of short-term sick-leave (more than 3 spells of less than 7 days' duration in a 12-month period) and long-term absence through sickness (at least 1 spell of more than 59 days' duration in a 12-month period) in relation to variables representing certain social circumstances and aspects of the work situation. Particular attention was paid to gender differences. The study, which had a cross-sectional design, employed data from the surveys of living conditions (ULF) conducted by Statistics Sweden over the period 1986-89. The study group comprised 13,828 employed persons between the ages of 16 and 65. The results suggested the existence of a common mechanism by which a variety of factors are related to the taking of both repeated short spells and long-term sick-leave; gender differences with regard to the effect of working conditions on the taking of sick-leave may be incorrectly estimated if factors related to occupational structure are not taken into consideration; a less than additive effect of physical job demands and repeated short spells of sick-leave on subjective health was found.
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| 5. |
- Blank, N, et al.
(författare)
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Social inequalities in the experience of illness in Sweden: a "double suffering"
- 1996
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Ingår i: Scandinavian journal of social medicine. - : SAGE Publications. - 0300-8037. ; 24:2, s. 81-89
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Tidskriftsartikel (refereegranskat)abstract
- This paper analyses the factors involved in differences in the experience of long-term illness (severe and non-severe illness), as measured in terms of self-reported frequency and intensity of symptoms. The study has a cross-sectional design. It uses a database from the Survey of Living Conditions of Statistics Sweden, and treats a representative sample of the employed Swedish population ( n = 13,501), aged between 16 and 65, interviewed over the period 1986–89. The results show that male manual workers report more non-severe and severe illness than non-manual workers, and that manual and lower-level non-manual female workers report more severe illness, but not non-severe illness, than intermediate/higher-level non-manual working females. The observed class differences in experience of severity of illness are partly explained by the factors investigated (job demands, personal economic difficulties, smoking daily, weak social network) in the case of men, and virtually entirely in the case of women. Other ill-health dimensions, such as self-rated general health and impaired working capacity, prove to be related to severity of illness, the latter being more strongly associated with experience of severe illness than the former irrespective of social class. The results lend support to the hypothesis that manual classes are subjected to what might be called “double suffering”; they have more long-term illnesses and also experience these illnesses with greater intensity and frequency.
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- Burstrom, B, et al.
(författare)
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Use of a historical register in social epidemiology: child mortality in Stockholm at the turn of the 19th century
- 1998
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Ingår i: Scandinavian journal of social medicine. - : SAGE Publications. - 0300-8037. ; 26:3, s. 166-172
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Tidskriftsartikel (refereegranskat)abstract
- This study describes the age- and cause-specific levels and social determinants of high child mortality in Stockholm around the turn of the century. The study is based on computerized individual level sociodemographic information and the death certificates of children aged 0-15 years residing in Maria parish in Stockholm during the years 1885, 1891 and 1910 (n=36 718) from a historical register (the Roteman archives). The usefulness of such data for further studies in social epidemiology is discussed. Age-specific rates and major causes of death compared well with other studies. Low social class and being born out of wedlock increased the overall risk of death in early childhood. Data appear valid and may be useful in social epidemiology. Further analyses of data from the Roteman archives may contribute to the understanding of causes behind high levels of cause- specific child mortality and trends in mortality in relation to societal change.
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| 15. |
- Diderichsen, F
(författare)
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Devolution in Swedish health care
- 1999
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Ingår i: BMJ (Clinical research ed.). - : BMJ. - 0959-8138 .- 1468-5833. ; 318:7192, s. 1156-1157
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Diderichsen, F, et al.
(författare)
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Trends in occupational mortality among middle-aged men in Sweden 1961-1990.
- 1997
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 26:4, s. 782-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Many European countries have in recent decades reported growing socioeconomic differentials in mortality. While these trends have usually paralleled high unemployment and increasing income disparities, Sweden had low unemployment and narrowing income differences. This study describes trends, 1961-1990, in total and cardiovascular mortality among men, 45-69 years of age, in major occupational classes in Sweden. METHODS: From census data four cohorts were created from those enumerated in 1960, 1970, 1980 and 1985. Through record linkage with the Swedish cause of death registry the mortality in each cohort was followed for 5-10 years. Age-standardized mortality trends 1961-1990 were calculated for occupational groups, categorized according to sector of the economy. RESULTS: The increase in mortality among middle-aged men in Sweden 1965-1980 was mainly a result of increasing cardiovascular mortality among industrial workers and farmers. In the 1980s the trend for these groups changed into a last decrease in mortality similar to that for non-manual occupations for the whole period. Consequently the rate ratio for industrial workers in comparison with men having a professional/managerial type of occupation increased from 0.98 to 1.43. The slowest decrease is now found among unqualified occupations in services and transportation. CONCLUSIONS: While Sweden, during the period studied, had narrowing income differentials and low unemployment this result points to the importance of working conditions in understanding trends and distribution of male adult mortality.
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| 21. |
- Hallqvist, Johan, 1950-, et al.
(författare)
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How to evaluate interaction between causes : a review of practices in cardiovascular epidemiology.
- 1996
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 239:5, s. 377-82
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Tidskriftsartikel (refereegranskat)abstract
- To increase the knowledge of interaction or synergy between risk factors in an important task in medical research. Still, current literature in cardiovascular epidemiology reflects major misconceptions as how to evaluate interaction. This paper presents Rothman's model of causation from which strict empirical criteria of interaction can be derived. In principle, the method to apply consists of comparing risk differences for one risk factor of interest across strata of the other. Commonly used but incorrect approaches are exemplified and discussed. These include reporting risk of disease among those with combined exposure, comparing relative risks for one exposure after stratification by level of the other, and including an interaction term in the regression model and drawing conclusions from its P-value.
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| 22. |
- Hallqvist, J, et al.
(författare)
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Interaction and model selection - Reply
- 1997
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Ingår i: JOURNAL OF INTERNAL MEDICINE. - 0954-6820. ; 241:6, s. 536-536
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 23. |
- Hallqvist, Johan, 1950-, et al.
(författare)
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Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? Results from Stockholm Heart Epidemiology Program (SHEEP).
- 1998
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 46:11, s. 1405-15
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Tidskriftsartikel (refereegranskat)abstract
- The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.
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| 24. |
- Hallqvist, Johan, 1950-, et al.
(författare)
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Socioeconomic differences in risk of myocardial infarction 1971-1994 in Sweden : time trends, relative risks and population attributable risks.
- 1998
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 27:3, s. 410-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The general trend in incidence of myocardial infarction (MI) in the Stockholm area changed from increasing to decreasing around 1980. The objective of this study is to examine time trends in incidence in major socioeconomic strata, relative risk between socioeconomic groups and population risk attributable to socioeconomic differences during this period. METHODS: All cases of MI from 1971 to 1986 were identified from hospital discharge and cause-of-death registers. Person-years for each year of follow-up were calculated from the population register in the Stockholm region 1971-1986. Census registers were used for information on socioeconomic status. Register information was individually linked through the Swedish personal identification number. Supplementary information for 1992-1994 was taken from the case-control study SHEEP (Stockholm Heart Epidemiology Program). RESULTS: The decline in MI risk among male high- and middle-level employees started in 1976 and in male manual workers in 1981. For women incidence increased from 1971 to 1986 among manual workers and decreased among high- and middle-level employees. The increase over time of the relative risk from low socioeconomic position continued into the 1990s. Despite the reduction of the category of manual workers, the population attributable risk from socioeconomic differences also increased over time. The process of social change influencing the size of the socioeconomic groups contributes to the change in time trends of MI morbidity. CONCLUSIONS: The increase over time of relative and population attributable risks of MI from low socioeconomic status add to the public health importance of social inequity.
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| 27. |
- Lindholm, C, et al.
(författare)
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Contingent valuation as a method for measuring the effects of rehabilitation
- 1998
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Ingår i: International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282. ; 21:1, s. 87-91
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Tidskriftsartikel (refereegranskat)
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| 28. |
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| 29. |
- Lundberg, M, et al.
(författare)
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Exposure-dependent misclassification of exposure in interaction analyses.
- 1999
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Ingår i: Epidemiology. - : Ovid Technologies (Wolters Kluwer Health). - 1044-3983 .- 1531-5487. ; 10:5, s. 545-9
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this paper are to analyze the consequences of exposure misclassification on effect estimates in interaction analysis, and to develop a mathematical equation for the potentially biased estimate. The main point is to identify situations in which misclassification of the first exposure, dependent on the second exposure but independent on outcome status, leads to overestimation or underestimation of the interaction effect. We show that misclassification theoretically can cause overestimation of the interaction effect. Nevertheless, because the categories that yield overestimation due to misclassification are fewer than the categories that yield underestimation, and misclassification in reality mostly is multidimensional (more than one category are biased simultaneously), it is more likely that the effect of misclassification is underestimation rather than overestimation. Misclassification in the categories that lead to overestimation is compensated by misclassification in the categories that lead to underestimation. The magnitude of the biased estimate depends on the prevalences of the misclassified exposure, stratified for the second exposure and the outcome-the lower the prevalence, the smaller the bias.
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| 30. |
- Möller, J, et al.
(författare)
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Do episodes of anger trigger myocardial infarction? A case-crossover analysis in the Stockholm Heart Epidemiology Program (SHEEP).
- 1999
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Ingår i: Psychosomatic Medicine. - : Ovid Technologies (Wolters Kluwer Health). - 0033-3174 .- 1534-7796. ; 61:6, s. 842-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility. METHODS: This study was a case-crossover study within the Stockholm Heart Epidemiology Program. Exposure in the period immediately preceding MI was compared with exposure during a control period for each case. From April 1993 to December 1994, 699 patients admitted to coronary care units in Stockholm County were interviewed. RESULTS: During a period of 1 hour after an episode of anger, with an intensity of at least "very angry," the relative risk of MI was 9.0 (95% CI, 4.4-18.2). In patients with premonitory symptoms, the time of disease initiation may be misclassified. When restricting the analyses to those without such symptoms, the trigger risk was 15.7 (95% CI, 7.6-32.4). The possibility of examining effect modification was limited by a lack of statistical power (eight exposed cases). Results of the analyses suggested, however, an increased trigger effect among subjects reporting nonhostile usual behavior patterns, nonovert strategies of coping with aggressive situations (not protesting when being treated unfairly), and nonuse of beta-blockers. CONCLUSIONS: The hypothesis that anger may trigger MI is further supported, with an increased risk lasting for approximately 1 hour after an outburst of anger. It is suggested that the trigger risk may be modified by personal behavior patterns.
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| 31. |
- Reuterwall, C, et al.
(författare)
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Higher relative, but lower absolute risks of myocardial infarction in women than in men : analysis of some major risk factors in the SHEEP study. The SHEEP Study Group.
- 1999
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 246:2, s. 161-74
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men. DESIGN: SHEEP (Stockholm Heart Epidemiology Program) is a population-based case-referent study of causes of MI (first event) in Swedish women and men aged 45-70 years. During the period 1992-94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case's sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia, hypertension, overweight, physical inactivity, smoking and job strain). RESULTS: The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101-180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman's synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking). CONCLUSIONS: The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.
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