| 1. |
- San Sebastián, Emil Xabier, et al.
(författare)
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Prevalence and risk factors for self-reported asthma among sámi in Sweden : a cross-sectional study
- 2023
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Ingår i: Journal of Asthma. - : Taylor & Francis. - 0277-0903 .- 1532-4303. ; 60:9, s. 1646-1652
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Literature about asthma among Indigenous communities worldwide is scarce. This study aimed to estimate the prevalence of self-reported asthma and to identify the risk factors associated with it among the Sámi population in Sweden.Methods: A population-based health study (SámiHET) was conducted among the Sámi population aged 18–84 years in 2021. The asthma outcome was self-reported. Potential risk factors included sociodemographic, socioeconomic, cultural, behavioral and psychosomatic factors. Frequencies and percentages of the independent variables and the outcome were calculated. Then, the magnitude of the association between the independent variables and asthma was summarized with the prevalence ratio (PR) using the 95% confidence interval (95% CI) for inferential purposes.Results: Overall, 20.6% of participants reported having asthma and 13.9% suffering from asthma with symptoms. Women (PR: 1.19; 95% CI: 1.01–1.42), those living in the Västerbotten region (PR: 1.35; 95% CI: 1.11–1.63) and those suffering financial strain (PR: 1.34; 95% CI: 1.07–1.69) had a higher risk of self-reported asthma. Among the psychosomatic factors, self-reported allergy (PR: 6.45; 95% CI: 5.11–8.17), overweight (PR: 1.46; 95% CI: 1.19–1.78) and obesity (PR: 1.75; 95% CI: 1.41–2.17) were statistically significant associated to asthma symptoms.Conclusion: A higher prevalence of asthma was found among the Sámi in Sweden compared to the average Swedish population. The associated risk factors were similar to those described in the literature. To understand the reason behind the higher prevalence of asthma among Sámi, more asthma-specific research, including register data, is needed.
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| 2. |
- Estalella, Itziar, et al.
(författare)
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Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay
- 2020
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Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 33, s. e33-e38
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.OBJECTIVE: The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.METHODS: The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.RESULTS: Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009).CONCLUSION: The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.
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| 3. |
- Abraha Derbew, Atakelti, 1976-
(författare)
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Bridging gaps in under-five child health : a comprehensive assessment of their social determinants and the health system performance in Tigray, Ethiopia
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Achieving the Sustainable Development targets related to child health necessitates a deep understanding of the multifaceted factors influencing their health.Aim: To comprehensively examine the social determinants of the access to, and quality of, child health services, and the performance of the health system in the region of Tigray.Methods: The study was conducted in six randomly selected rural districts of Tigray. The study employed focus group discussions and interviews (sub-study I), a retrospective case-control study (sub-study-II), a capture recapture method (sub-study III), and a two-stage mortality survey (sub-study IV).Results: Sub-study I: underscored a good knowledge on the causes and management of common childhood morbidity, and that the health posts were conveniently located and provided trusted services. However, several barriers to using health services were identified. These included cultural beliefs, seasonal mobility, economic constraints, limited decision-making power for women, and accessibility challenges.Sub-study II: Revealed that only 76% of eligible children born to HIV-positive mothers were tested, with 17% testing positive for HIV, and only 29% of them linked to anti-retroviral treatment.Sub-study III showed that the concordance correlation coefficient between the Family Folder data and the household survey for the total population, reproductive age women, and under-five year child population were all above 0.73, while they were close to zero for other child health parameters. Tracing and recording neonatal deaths, and the aggregation of data at various levels were the major operational challanges.Sub-study IV identified infectious diseases (52.9%), neonatal causes (35.6%), nutritional disorders (6.6%) and external causes (4.3%) as the major causes of child death. The cause for 76 (16.2%) children was indeterminate. Tracing neonatal deaths and logistical challenges, especially in remote areas were the major operational issues of conducting the mortality survey.Conclusion: In spite of the improvements in health literacy, access to cost-free reproductive, maternal, neonatal and child health services and improved utilization, various interrelated social determinants, including cultural beliefs, financial barriers and health system-related factors continue to hinder the optimal utilization of essential child health services. Moreover, the health system’s performance in the prevention of mother-to-child transmission of HIV and its effect in reducing mortality among exposed children is generally poor. Policymakers in the region should focus on tackling those social determinants, including the health system, to improve children´s health. The community health information system showed promising potential. However, the operational issue of capturing neonatal deaths adequately and the process by which community data can be aggregated upwards through the health system has to be improved. The study underscored the viability of implementing a cause-specific mortality survey using health extension workers, and the need to standardize data collection tools and logistics before implementation on a larger scale.
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| 4. |
- Amani, Paul Joseph, 1975-
(författare)
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Does health insurance contribute to improving responsiveness of the health system? : the case of elderly in rural Tanzania
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Financing healthcare in Tanzania has for years depended on out-of-pocket payments. This mechanism has been criticized as being inefficient, contributing to inequity and high cost as well as denying access to healthcare to those most in need, including the elderly in rural areas. Health insurance (HI) was recently introduced as an instrument to enable equitable access to healthcare and thus to improve the responsiveness of the health system. Even though health insurance is expected to bring benefits to those who are insured, there is a lack of specific studies in the country looking at the role of HI in facilitating the health system responsiveness among vulnerable populations of remote areas.Aim: The aim of this thesis is to understand if and how health insurance contributes to improving the responsiveness of the healthcare system among the elderly in rural Tanzania. Methods: Four interrelated sub-studies (2 quantitative and 2 qualitative) were conducted in Igunga and Nzega districts of Tabora region between July 2017 and December 2018. The first two sub-studies are based on a household survey using an adapted version of the World Health Organization’s Study on Global Ageing and Adult Health questionnaire. Elderly people aged 60 years and above who had used both outpatient and inpatient healthcare three and twelve months prior to the study, respectively, were interviewed. Whereas in sub-study 1 the focus was to investigate the role of health insurance status on facilitating access to healthcare, sub-study 2 assessed the relationship between health insurance and the health system responsiveness domains. In sub-study 3, interviews with healthcare providers were carried out to capture their perspective regarding the functioning of the health insurance. In the final sub-study 4, focus group discussions with elderly were conducted in order to explore their experience of healthcare, depending on their health insurance status. Crude and adjusted logistic and quantile regression models were applied to analyse the association between health insurance and access to healthcare (sub-study 1) and responsiveness (sub-study 2), respectively. For both sub-studies 3 and 4, qualitative content analysis was used to analyse the data.Results: Sub-studies 1 and 2 involved a total of 1899 insured and uninsured elderly, while sub-studies 3 and 4 included 8 health providers and 78 elderlies respectively. Sub-study 1 showed that about 45% of the elderly were insured and HI ownership improved access and utilization of healthcare, both outpatient and inpatient services. In sub-study two, however, health insurance was associated with a lower responsiveness of the healthcare system. In general, all six domains: cleanliness, access, confidentiality, autonomy, communication, and prompt attention were rated high, but three were of concern: waiting time; cleanliness; and communication. Sub-study 3 uncovered several challenges coexisting alongside the provision of insurance benefits and thus contributing to a lower responsiveness. These included shortage of human resources and medical supplies, as well as operational issues related to delays in funding reimbursement. In sub-study 4, the elderly revealed that HI did not meet their expectations, it failed to promote equitable access, provided limited-service benefits and restricted use of services within residential areas. Conclusion: While HI seems to increase the access to and use of healthcare services by the elderly in rural Tanzania, a lower responsiveness by the healthcare system among the insured elderly was reported. Long waiting times, limited-service benefits, restricted use of services within schemes, lack of health workforce in both numbers and skills as well as shortage of medical supplies were important explanations for the lower responsiveness. The results of this thesis, while supporting the national aim of expanding HI in rural areas, also exposed several weaknesses that require immediate attention. There is a need to, first, review the insurance policy to improve its implementation, expand the scope of services coverage, and where possible, to introduce cross-subsidization between the publicly owned schemes; additionally, improvements in the healthcare infrastructure, increasing the number of qualified health workforce and the availability of essential medicines and laboratory services, especially at the primary healthcare facilities, should be prioritized and further investments allocated.
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| 5. |
- Amani, Paul Joseph, et al.
(författare)
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Health insurance and health system (un) responsiveness : a qualitative study with elderly in rural Tanzania
- 2021
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania.METHOD: An explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems' responsiveness. Qualitative content analysis was used to analyse the data.RESULTS: Elderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare.CONCLUSIONS: The national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients' communication skills and care rights is highly recommended.
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| 6. |
- Amani, Paul Joseph, et al.
(författare)
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Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania : an explorative qualitative study
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.
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| 7. |
- Amani, Paul Joseph, et al.
(författare)
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Responsiveness of health care services towards the elderly in Tanzania : does health insurance make a difference? A cross-sectional study
- 2020
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Ingår i: International Journal for Equity in Health. - : Springer Nature. - 1475-9276. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population.Methods: A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors.Results: A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (− 1; 95% CI: − 1.45, − 0.45) and inpatient (− 2; 95% CI: − 2.69, − 1.30) care.Conclusion: The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.
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| 8. |
- Anyatonwu, Obinna Princewill, et al.
(författare)
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Rural-urban disparities in postpartum contraceptive use among women in Nigeria : a Blinder-Oaxaca decomposition analysis
- 2022
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Ingår i: International Journal for Equity in Health. - : Springer Nature. - 1475-9276. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Unintended pregnancies are a global public health concern that could be prevented with appropriate access to contraceptive methods. Evidence from research has indicated that avoidance of closely space birth/pregnancy within the first year of postpartum, mitigates the risk of adverse health outcomes such as preterm birth, low birth-weight, etc. Postpartum family planning helps women to minimize closely spaced and unplanned pregnancies within the first 12 months after delivery. Less contraceptive use is often present in more socially disadvantaged groups. Studies from Nigeria have shown a persistent disparity on contraceptive use between rural and urban residents. To identify the factors explaining these inequalities is important to implement targeted interventions. This study aimed to identify the factors contributing to the rural-urban disparity in postpartum contraceptive use among women in Nigeria. Methods: This is a cross-sectional study using the Nigerian Demographic Health Survey. In total, 28,041 postpartum Nigerian women were included. Self-reported contraceptive use was the outcome, while the selected explanatory variables were grouped according to three theoretical perspectives: materialistic, behavioural/cultural, and psychosocial variables. Descriptive statistics and Blinder-Oaxaca decomposition were used to summarize and identify the factors contributing to the rural-urban disparity in postpartum contraceptive use. Results: In this study, 27% of women reported to have used contraceptives during the postpartum period. The rural-urban disparity in postpartum contraceptive use accounted for 18.2 percentage points. The findings further showed that the disparities in postpartum contraceptive use between rural-urban residence were mostly explained by materialistic variables (82%), followed by the behavioural/cultural variables and age (included as covariate) accounting for 15.6 and 3.0%, respectively. Household wealth (37%) and educational attainment (38%) had the most significant contribution to the differences in postpartum contraceptive use. Only 15% of the difference in postpartum contraceptive use remained unexplained. Conclusion: This study has shown important inequalities in postpartum contraceptive use between rural and urban residents in Nigeria. These differences were mainly explained by materialistic factors. These findings highlight crucial areas for the government to target in order to close the existing gap between rural and urban settings in contraceptive use in the country.
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| 9. |
- Arce Cardozo, Rodrigo Karlop, 1987-, et al.
(författare)
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Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? : an interrupted time series analysis
- 2024
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Ingår i: Global Health Action. - : Taylor & Francis Group. - 1654-9716 .- 1654-9880. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The COVID-19 pandemic prompted varied policy responses globally, with LatinAmerica facing unique challenges. A detailed examination of these policies’ impacts on healthsystems is crucial, particularly in Bolivia, where information about policy implementation andoutcomes is limited.Objective: To describe the COVID-19 testing trends and evaluate the effects of quarantinemeasures on these trends in Cochabamba, Bolivia.Methods: Utilizing COVID-19 testing data from the Cochabamba Department Health Servicefor the 2020–2022 period. Stratified testing rates in the health system sectors were firstestimated followed by an interrupted time series analysis using a quasi-Poisson regressionmodel for assessing the quarantine effects on the mitigation of cases during surge periods.Results: The public sector reported the larger percentage of tests (65%), followed by theprivate sector (23%) with almost double as many tests as the public-social security sector(11%). In the time series analysis, a correlation between the implementation of quarantinepolicies and a decrease in the slope of positive rates of COVID-19 cases was observedcompared to periods without or with reduced quarantine policies.Conclusion: This research underscores the local health system disparities and the effective-ness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabambaregion. The findings stress the importance of the measures’ intensity and duration, providingvaluable lessons for Bolivia and beyond. As the global community learns from the pandemic,these insights are critical for shaping resilient and effective health policy responses.
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| 10. |
- Arias Fuentes, Fara Faith, et al.
(författare)
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Social inequalities in women exposed to obstetric and gyneco-obstetric violence in Ecuador : a cross-sectional study
- 2022
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Ingår i: BMC Women's Health. - : BioMed Central (BMC). - 1472-6874. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obstetric and gyneco-obstetric violence (OV, GOV) is a concerning public health problem, particularly in Latin America. This study aimed to determine the prevalence of OV and GOV and to assess its socio-geographical distribution in Ecuador.Methods: This cross-sectional study used data from a national survey conducted in 2019 (n = 17,211) among women aged 15 years and over. Independent variables included age, marital status, education, ethnicity, place of residence and region. The chosen outcomes were lifetime experience of OV and GOV. Frequency tables were calculated and crude and adjusted regression models estimating prevalence ratios and their 95% confidence intervals were computed.Results: Nearly one-third (32.8%) of the participants had experienced OV and two-fifths (41.86%) GOV at least once in their lifetime. Prevalence of OV were particularly common in women 26–35 and 46–55 years old, with primary or middle education and in urban regions. In comparison, GOV had a higher prevalence in women aged > 65 years and with no formal education. Both subtypes of violence were more common among women with current or earlier partners compared with the single ones. Also the two outcomes were more prevalent in the non-white population, OV among the populations of colour (POC), while GOV both, in the POC and Indigenous group. Additionally, women from the Highlands and Amazon reported higher OV and GOV than the Coastal group.Conclusion: Our study showed that OV and GOV are common in Ecuador and identified an unequal distribution of their prevalence across different socio-geographical groups. Further studies including more social factors and a continuous monitoring of OV and GOV are recommended. Current policies, laws to protect women and guidelines regarding the treatment of women, particularly in health care settings, need to be constantly advocated for and effectively implemented in the country.
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| 11. |
- Aweesha, Huzeifa, 1980-, et al.
(författare)
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Sudan's health sector partnership : from confined progression to openness and hope to uncertain demise
- 2024
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Ingår i: Development Policy Review. - : John Wiley & Sons. - 0950-6764 .- 1467-7679. ; 42:2
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Tidskriftsartikel (refereegranskat)abstract
- Motivation: Despite signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the effective development cooperation (EDC) principles for better health cooperation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study: the country adopted a local health compact in 2014, but for much of the time since the regime was under sanction. Sudan witnessed a revolution in 2018, followed by a counter-coup in 2021.Purpose: We aim to explore the evolution of Sudan health sector partners’ relationships, perspectives, and adherence to EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022.Methods and approach: We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded then sorted into themes.Findings: Prior to the 2019 revolution cooperation was progressive but restricted, with civil society marginalized and a dominating government. The principles, especially ownership, were misused and misaligned with national priorities driven by donors’ interests and conditions.The transitional (post-revolution) period witnessed partners’ openness and influx, but unstable leadership and subsequent changes in priorities led to wasted opportunities.Following the coup, donors adopted a no-contact policy towards the de facto government. Instead, the expectation was that civil society organizations would replace the government as the main implementers. Overall, limited coordination capacity and no sustainability measures were present throughout.Policy implications: Much of what was observed was down to the often complicated and difficult context of the governance of Sudan. That said, general issues arose including the government's ability to coordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and to empower civil society organizations. Within a complex and volatile context, revisiting partners’ commitments through joint compact reviews and transparent EDC progress monitoring is crucial.
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| 12. |
- Baroudi, Mazen, et al.
(författare)
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Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare : A Cross-sectional Survey
- 2022
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Ingår i: International Journal of Health Policy and Management. - : Kerman University of Medical Sciences. - 2322-5939. ; 11:3, s. 287-298
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. Methods: A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. Results: Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). Conclusion: There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.
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| 13. |
- Baroudi, Mazen, et al.
(författare)
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Social factors associated with trust in the health system in northern Sweden : a cross-sectional study
- 2022
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the importance of having trust in the health system, there is a paucity of research in this feldin Sweden. The aim of this study was to estimate the level of trust in the health system and to assess the factors asso‑ciated with it in northern Sweden.Methods: A cross-sectional survey was conducted in 2014 in the four northern regions of Sweden. A total of 24 795 participants (48% response rate) aged 18 to 84 years were involved in the study. A log-binomial regression was usedto measure the association between sociodemographic factors and trust in the health system.Results: Two thirds of the participants (68.5%) reported high trust in the health system i.e. had very much or quitea lot confdence in the health system. Women had lower prevalence of trust compared to men (PR=0.96; 95%CI=0.94–0.98) while older participants had a higher trust compared to youth (PR=1.11; 95% CI=1.06–1.16). Participants with lower level of education, those who experienced economic stress, those who were born outside Swedenand those living in small municipalities also had lower prevalence of trust in the health system. Conversely, lowerincome was associated with higher trust (PR=1.08; 95% CI=1.04–1.12). Finally, a strong relationship between highersocial capital (having emotional and instrumental support, horizontal trust, and higher social participation) and trustin the health system was also found.Conclusions: Trust in the health system was moderately high in northern Sweden and strongly associated withsociodemographic and social capital factors. Trust is a complex phenomenon and a deeper exploration of the relationbetween trust in the health system and sociodemographic factors is needed.
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| 14. |
- Baroudi, Mazen, et al.
(författare)
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The perception of youth health centres' friendliness : does it differ between immigrant and Swedish-Scandinavian youths?
- 2020
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 30:4, s. 780-785
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ensuring a good quality service and equal access according to need for all young people is a key objective of the Swedish health system. The aim of this study was to explore youths’ perception of youth health centres’ (YHCs’) friendliness and to assess the differences in perception between immigrant and Swedish-Scandinavian youths.Methods: All YHCs in the four northern counties in Sweden were invited (22 centres), and 20 agreed to participate. Overall, 1089 youths aged 16–25 years answered the youth-friendly health services-Sweden questionnaire between September 2016 and February 2017. Thirteen sub-domains of friendliness were identified and their scores were calculated. Multilevel analysis was used to examine the differences in perception between immigrant and Swedish-Scandinavian youths.Results: Our sample consisted of 971 Swedish-Scandinavian youths (89.2%) and 118 immigrants (10.8%). Generally, both groups perceived the services to be very friendly. All 13 sub-domains were rated more than three in a four-point scale except for fear of exposure and parental support of psychosocial services. However, immigrant youths perceived YHCs less friendly than their counterparts, particularly regarding the domains of equity, respect, quality and parental support.Conclusions: Our study suggests that even though youths perceived YHCs as highly friendly, there is a space for improvement regarding access to health care. Our findings highlight the importance of an open and culturally sensitive attitude of the staff and the need to engage parents and community as a key to improve immigrant youths’ accessibility to health care.
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| 15. |
- Baroudi, Mazen, et al.
(författare)
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Young migrants' sexual rights in Sweden : a cross-sectional study
- 2021
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. A self-administered questionnaire was used to collect data from 1773 young (16 - 29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.
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| 16. |
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| 17. |
- Blåhed, Hanna, et al.
(författare)
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"Det är ju faktiskt framtiden som tas ifrån en" : en hälsokonsekvensbedömning med anledning av den potentiella gruvetableringen i Gállok/Kallak, svenska Sápmi
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Inledning: Denna rapport avser den potentiella gruvetableringen i Gállok/Kallak, ett område 4 mil utanför Jokkmokk, svenska Sápmi. Markerna kring Gállok/Kallak används till renskötsel året om av samebyn Jåhkågasska tjiellde. En gruvetablering skulle påverka renarnas migrationsrutt avsevärt, och försvåra hållbar renhållning för samebyn. Det skulle också medföra högre utfordrings– och transportkostnader för renskötarna, potentiellt öka konflikterna mellan samebyarna, och för många skulle det innebära slutet på ett traditionellt leverne. Även om miljökonsekvensbeskrivningar (MKB) genomförs enligt lag vid alla typer av utvecklingsprojekt, så bedöms hälsa oftast vagt och ytligt i dessa, och potentiella hälsoeffekter på lokalbefolkningen bedöms sällan. Syftet med denna hälsokonsekvensbedömning (HKB) var således att utröna hälsoeffekter bland medlemmar i Jåhkågasska tjiellde sameby, med anledning av det planerade gruvverksamheten i Gállok/Kallak.Metod: Metoden som användes kallas HKB och är ett femstegsverktyg, rekommenderat av bland annat Folkhälsomyndigheten. Stegen inkluderar i) screening ii) tillämpningsområde iii) bedömning iv) presentation av resultat och rekommendationer och v) övervakning och utvärdering, varav alla förutom det sista steget har genomförts. Steg i) –ii) undersökte förutsättningarna för en HKB. Steg iii) bestod av en litteraturöversikt, följt av en kvalitativ studie. Steg iv) bestod i rapportskrivning med rekommendationer. Gällande den kvalitativa delen genomfördes djupintervjuer med sex deltagare från Jåhkågasska tjiellde, för att fånga nuvarande och potentiella framtida hälsoupplevelser med anledning av den tilltänkta gruvan. Tematisk analys användes för att tolka data.Resultat: Resultatet av litteraturöversikten visade att få studier har undersökt hälsorisker i förhållande till lokalbefolkningar. Trots att gruvetableringar ofta planeras på mark som har kopplingar till urfolk så finns få hälsobedömningar i relation till urfolk. Ur intervjuerna framkom fem teman, uppdelade i två avsnitt: “Nuvarande hälsoeffekter och dess bakomliggande orsaker” och “Potentiella framtida hälsoeffekter och dess bakomliggande orsaker”. Under nuvarande effekter diskuterades maktobalansen mellan de olika aktörerna under temat “Det är som Davids kamp mot Goliat”. I detta avsnitt presenterades även de specifika hälsoeffekterna som uppkommit som ett resultat av den långa gruvprocessen, under temat “Det är en långsam process som tar mycket kraft och energi”. Det sista temat i det första avsnittet “Det är som ett försvar (…) som för att skydda sig själv” avslöjade de olika strategier som deltagarna utvecklat för att hantera situationen. Två temat uppstod under potentiella framtida effekter: “Om renen dör, dör allt” och “Man skulle känna att man inte har någon makt, [man skulle känna sig] åsidosatt, bortryckt, inte omtyckt”. Det förstnämnda temat skildrade den negativa påverkan av en potentiell gruva på renskötseln, medan den senare presenterade konkreta hälsokonsekvenser utav densamma.Slutsats: Resultaten av studien visade att planerna på en gruva i Gállok/Kallak redan har gett upphov till negativa psykosociala hälsoeffekter i Jåhkågasska tjiellde. Detta var oväntat, då HKB betraktas som ett framtidsorienterat verktyg. Nuvarande hälsoeffekter inkluderade ångest, stress och oro, medan potentiella framtida effekter pekade på försämrad psykisk hälsa. Osäkerheten kring beslut, den långa väntan och rädslan för att förlora ens försörjning – inklusive den framtida generationens försörjning – medverkade till nuvarande, och potentiellt försämrad, psykisk hälsa. 5 Fyra rekommendationer presenteras i denna rapport: i) HKB bör regleras i lag och bli praxis i alla utvecklingsprojekt; ii) HKB bör undersöka och övervaka både nuvarande och framtida hälsoeffekter; iii) HKB bör genomföras på ett systematiskt, deltagande och öppet sätt, och ges samma vikt i beslutsfattande som MKB; v) stöd för att förhindra psykisk ohälsa bör erbjudas i början av varje utvecklingsprojekt.
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| 18. |
- Blåhed, Hanna, et al.
(författare)
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Health impact assessment of a mining project in Swedish Sápmi : lessons learned
- 2022
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Ingår i: Impact Assessment and Project Appraisal. - : Taylor & Francis Group. - 1461-5517 .- 1471-5465. ; 40:1, s. 38-45
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Tidskriftsartikel (refereegranskat)abstract
- Whereas assessing health is a mandatory feature of environmental impact assessments (EIAs) in Sweden, health impacts are often vaguely described, making their health preventive role meaningless. In 2006, a mine was planned in the reindeer grazing lands of a Sámi community in northern Sweden. While an EIA was conducted in 2013, health was superficially addressed. The aim of this study was to describe and reflect on the health impact assessment (HIA) process that assessed the potential health risks and/or benefits that the mine establishment could bring to the Sámi community.The classic five steps of an HIA are presented. The literature review showed a scarcity of studies regarding HIA on mining in indigenous territories. Participants in the study were currently experiencing negative psychosocial health effects and described potential adverse social and health effects originating from the loss of their traditional way of life.Despite certain challenges, this study proved that it is possible to conduct a comprehensive HIA in the context of Sámi health research. Given that mining in Sweden occurs mostly in Sámi territory and the adverse health effects found in this study, the lack of comprehensive HIAs on mining projects in Sweden raises serious concerns.
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| 19. |
- Blåhed, Hanna, et al.
(författare)
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“If the reindeer die, everything dies”: The mental health of a Sámi community exposed to a mining project in Swedish Sápmi
- 2021
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Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis. - 1239-9736 .- 2242-3982. ; 80:1
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Tidskriftsartikel (refereegranskat)abstract
- In 2006, a British mining company started the process of extracting ore from Gállok/Kallak, in Swedish Sápmi. These grounds are used all year round for reindeer herding by the Sámi community Jåhkågasska tjiellde. While environmental impact assessments should be conducted by law in any development project in Sweden, the health component included is usually vague. The aim of this study was to understand the experiences and perceptions of the Sámi community regarding the current and potential health effects of the proposed mine.A qualitative study, including six in-depth interviews with members of the community, was conducted in 2020. Interviews were analysed using thematic analysis. Five themes were identified and organised in current and future impacts. Current impacts included “It’s like David’s battle against Goliath”, “It’s a slow process that takes a lot of power and energy”, “It’s a defense … like, to protect oneself”; with future impacts including: “If the reindeer die, everything dies”, “You would feel that you do not possess any power, [you would feel] overridden, pushed away, not liked”.The fear of losing current and future generations’ livelihoods appeared to be the main mediators of the current and potential worsened mental health experienced by the community.
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| 20. |
- Brandén, Jennie, 1984-, et al.
(författare)
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Våld mot samiska kvinnor
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I den här rapporten presenterar vi resultat från forskningsprojektet ”Våld mot samiska kvinnor” som 2021-2024 genomförts av forskargruppen Lávvuo vid Umeå Universitet, på uppdrag av Sámediggi (Sametinget i Sverige).Rapporten består av en kvantitativ och en kvalitativ del, samt fem åtgärdsförslag riktade till Sveriges regering.De kvantitativa resultaten i korthetDen kvantitativa delen av rapporten baseras på enkätundersökningen Samisk hälsa på lika villkor som genomfördes 2021. Resultaten har jämförts med Sveriges befolkning genom den nationella enkäten Sexuell och reproduktiv hälsa genomförd 2017. Det övergripande mönstret är att kvinnor är betydligt mer utsatta för våld än män, samt att samiska kvinnor 2021 uppger en högre våldsutsatthet än kvinnor i Sverige 2017, för de flesta typer av våld.Över hälften av de samiska kvinnorna har utsatts för sexuellt våld (55,5 procent), sju av tio har utsatts för psykiskt våld (68,5 procent) och nästan var tredje för fysiskt våld (27,9 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för de grövsta formerna av sexuellt våld, såsom våldtäktsförsök (14,1 jämfört med 10,6 procent) och våldtäkt (10,3 jämfört med 7,0 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för psykiskt våld, både sammantaget (68,5 jämfört med 50,9 procent) och vad gäller alla de former av psykiskt våld som undersöktes.Även när det gällde fysiskt våld rapporterade samiska kvinnor (27,9 procent) en högre utsatthet jämfört med kvinnor i Sverige (22,0 procent).Samiska kvinnors utsatthet för våld varierar med både ålder och geografi. Överlag var utsattheten högst bland kvinnor yngre än 45 år. Geografiskt var utsattheten för sexuellt och fysiskt våld högre bland samiska kvinnor i mellersta och södra Sverige, med undantag av Stockholmsområdet. För psykiskt våld hade samiska kvinnor i Jämtland Härjedalen en högre utsatthet.Det finns flera starka samband mellan olika typer av våldsutsatthet och psykisk och fysisk ohälsa. Upprepad våldsutsatthet (fler än en gång) är förenat med ännu högre risk för ohälsa, särskilt psykisk ohälsa. Starkast är detta samband när det gäller stress och självmordstankar.När det gäller diskriminering och rasism uppger en betydande andel av samer i Sverige att de utsatts någon gång i livet. Liksom för andra former av våld i denna undersökning visar analysen att en högre andel samiska kvinnor (44,5 procent) utsatts jämfört med samiska män (37,0 procent).HBTQ-samer är mer våldsutsatta än andra samer. Detta gäller sexuellt våld (64,6 jämfört med 30,9 procent), psykiskt våld (81,7 jämfört med 58,4 procent) och fysiskt våld (43,8 jämfört med 25,5 procent).De kvalitativa resultaten i korthetDen kvalitativa delen baseras på intervjuer med professionella som arbetar inom samhällets stödstrukturer för våldsutsatta i olika delar av den svenska delen av Sápmi.Intervjustudien visar att våld mot samiska kvinnor är en fråga som behöver förstås i relation till den bredare politiska och historiska, koloniala, och könade kontext som våldet utspelar sig i.Frågan om våld mot samiska kvinnor osynliggörs och beskrivs som svår att adressera – både i det samiska samhället och i majoritetssamhället.Kunskapen om det samiska samhället är låg inom samhällets stödstrukturer. Deltagare beskrev att samiska perspektiv saknas i styrdokument kring mäns våld mot kvinnor och i befintlig terminologi. Detta gör att förhållanden i det samiska samhället som kan påverka den våldsutsattas situation negligeras i mötet med samiska klienter, patienter och brukare som utsätts för våld.Frågan om våld mot samiska kvinnor beskrevs som ”känslig” och ”laddad”. Sammantaget framträder ett stigma kring frågan och en oro för att ”göra fel” eller bidra till fördomar och rasism mot samer, både i det samiska samhället och majoritetssamhället.Problemet med våld mot samiska kvinnor beskrevs som svår att adressera inom en redan marginaliserad samisk kontext, där värnandet av samiska kollektiva rättigheter har prioriterats.Det finns en rad särskilda förhållanden knutna till det samiska samhället som är viktiga att ha kunskap om och vara lyhörd för i mötet med våldsutsatta samiska personer och i arbetet för att motverka våld mot samiska kvinnor.Närheten och lokalkännedomen i mindre samhällen beskrevs som styrkor, men samtidigt lyftes utmaningar såsom bristande anonymitet, resurser, kompetens och insatser. Svårigheten att vara anonym och långa geografiska avstånd till samhällets stöd beskrevs som extra påtagligt i det samiska samhället. Stark samhörighet i det samiska samhället beskrevs som positivt men också potentiellt problematiskt när det gäller den utsattas situation.Bristande tillit till myndigheter bland samer är en potentiell barriär för att nå och stötta våldsutsatta samiska kvinnor. Den bristande tilliten relaterades till både historiska och samtida erfarenheter av okunskap, förtryck, rasism och diskriminering.Deltagare beskrev ojämställdhet och tystnad kring våld mot kvinnor i det samiska samhället, och att våld mot kvinnor ofta hanteras internt. Tystnaden knöts till en lojalitet med samiska män, ett ideal att samiska kvinnor ska vara starka och klara sig själva, samt en vilja att skydda familjen och det samiska kollektivet.Ett centralt hinder för utsatta kvinnor att lämna en våldsam relation beskrevs vara rädslan för att uppbrottet skulle innebära förlust av deras samiska sammanhang. Ens samiska identitet beskrevs till exempel som nära knuten till platsen och markerna och därmed som svår att upprätthålla vid flytt till en annan ort för att söka skydd.Åtgärdsförslag till Sveriges regeringBaserat på de utvecklingsbehov som identifierats genom detta forskningsprojekt utmynnar rapporten i fem åtgärdsförslag riktade till den svenska regeringen.Uppdra åt Sametinget att följa upp och samordna arbetet för att motverka våld mot samiska kvinnor.Utforma en nationell policy för att motverka våld mot samiska kvinnor.Utveckla stödstrukturer för våldsutsatta samiska kvinnor och flickor.Genomför kortsiktiga utbildningsinsatser.Säkra långsiktig kunskapsproduktion och kompetenshöjning.
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| 21. |
- Brattlöf, Frida, et al.
(författare)
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Prevalence and change in social inequalities in physical activity before and during the COVID-19 pandemic in Sweden
- 2023
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Ingår i: International Journal for Equity in Health. - : BioMed Central (BMC). - 1475-9276. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physical activity is crucial for our wellbeing. Since the COVID-19 pandemic emerged, physical activity behaviour has changed globally, and social inequalities that already exist in physical activity have increased. However, there is limited knowledge of how these inequalities have evolved in Sweden. Thus, the aim of this study was to assess the prevalence of physical activity, and the socioeconomic inequalities in physical activity before and during the COVID-19 pandemic.Methods: This study analysed data from the national ‘Health on Equal Terms’ survey which was conducted on participants between 16 and 84, through a repeated cross-sectional design in 2018 (pre-pandemic) and 2021 (during the pandemic). The socioeconomic variables included gender, age, education, occupation, income, and place of birth. For both years, the prevalence of low physical activity, the absolute risk differences, the slope index of inequality, and the slope index difference for each of the variables were calculated.Results: The level of physical activity increased for the total population studied. However, the social inequalities that existed in 2018 increased over time and across age, education, occupation, income, and place of birth, but not with regard to gender.Conclusions: Even though the Swedish population increased their levels of physical activity during the COVID-19 pandemic, the social inequalities that already existed in physical activity increased. Interventions to increase the level of physical activity among the young, people with low socioeconomic status, and those born outside Sweden are needed to reduce these social inequalities, and to improve the Swedish population’s wellbeing.
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| 22. |
- Castel-Feced, Sara, et al.
(författare)
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Exploring sex variations in the incidence of cardiovascular events : a counterfactual decomposition analysis
- 2024
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 34:3, s. 578-583
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Tidskriftsartikel (refereegranskat)abstract
- Background: Some cardiovascular risk factors (CVRFs) that occur differently in men and women can be addressed to reduce the risk of suffering a major adverse cardiovascular event (MACE). Furthermore, the development of MACE is highly influenced by social determinants of health. Counterfactual decomposition analysis is a new methodology that has the potential to be used to disentangle the role of different factors in health inequalities. This study aimed to assess sex differences in the incidence of MACE and to estimate how much of the difference could be attributed to the prevalence of diabetes, hypertension, hypercholesterolaemia and socioeconomic status (SES).Methods: Descriptive and counterfactual analyses were conducted in a population of 278 515 people with CVRFs. The contribution of the causal factors was estimated by comparing the observed risk ratio with the causal factor distribution that would have been observed if men had been set to have the same factor distribution as women. The study period was between 2018 and 2021.Results: The most prevalent CVRF was hypercholesterolaemia, which was similar in both sexes, while diabetes was more prevalent in men. The incidence of MACE was higher in men than in women. The main causal mediating factors that contributed to the sex differences were diabetes and SES, the latter with an offsetting effect.Conclusions: This result suggests that to reduce the MACE gap between sexes, diabetes prevention programmes targeting men and more gender-equal salary policies should be implemented.
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| 23. |
- Daca, Chanvo Salvador Lucas, 1976-
(författare)
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Making the connections : understanding inequalities in reproductive and child health in Mozambique
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Mozambique, despite significant socio-economic and health system challenges, there has been progress in reproductive and child health in recent years. However, there is still a lack of comprehensive studies that thoroughly unravel the socio-economic determinants of health and health inequalities in the country.The overall aim of this thesis was to understand the socio-economic and geographic inequalities in reproductive and child health with the intention of informing and optimizing the implementation of targeted health programmes in Mozambique.Methods: This thesis is based on three sub-studies that used data obtained from population-based health surveys. In sub-study I, prevalence ratios (PRs) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship of socio-economic, demographic, and geographic characteristics with three outcomes of interest: insecticide-treated bed nets (ITNs), child immunization coverage and modern contraceptive use. Sub-study II used the concentration index (Cindex) and decomposition analysis to assess the socio-economic and regional contributions to the wealth inequality in health preventive care. Sub-study III estimated absolute risk differences and the slope index of inequality (SII) as the measures of association between the socio-economic variables and the outcomes (ITN use, fever treatment and Fansidar prophylaxis) for the 2015 and 2018 surveys, as well as for the differences between the two time points.Results: The proportion of mothers with at least one child aged under five years that did not use an ITN was 51.01%, while 46.25% of women had children aged one to four years who were not fully immunized and 74.28% of women did not use modern contraceptives. Non-educated mothers and residents of the southern region were more likely to report not using an ITN (PR = 1.36; 95% CI: 1.17–1.59), while those in the lowest wealth quintile had a higher chance of having children who were not fully immunized (PR = 1.34; 95% CI: 1.04–1.71). Similarly, non-educated mothers (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16) and those in the poorest wealth quintile (PR = 1.13; 95% CI: 1.04–1.24) were more likely to not use modern contraception (sub-study I). Sub-study II found a Cindex of -0.081 for non-ITN, -0.189 for a lack of vaccination coverage and -0.284 for non-contraceptive use, showing a worse health outcome among the poorest population. The study revealed that 88.41% of the wealth gap for ITNs was explained by socio-economic factors, with education and wealth playing the largest roles. With regard to the lack of full vaccination, socio-economic factors (47.74%), particularly the wealth quintile (35.79%), emerged as the predominant contributor to the inequality. Similarly, socio-economic factors (39.39%) were also the main explanatory factors for the lack of contraceptive use, but to a lesser degree than for the other two outcomes (sub-study II). Access to health preventive activities increased in all of the three studied outcomes between 2015 and 2018. Significant reductions in ITN inequality were observed for all socio-economic variables, but no decrease of inequalities in fever treatment and Fansidar prophylaxis was found over time (sub-study III).Conclusion: This thesis revealed that bed net use and immunization coverage among children, and modern contraceptive use among women, were notably low. There was inequality, concentrated among the poor, in reproductive and child preventive measures. The greater part of this inequality could be attributed to low wealth and education, as well as to residence in rural areas. Reductions in socio-economic inequalities between 2015 and 2018 were observed for ITN use but not for fever treatment or malaria prophylaxis. Based on these findings, achieving universal health coverage in Mozambique will require an equitable resource distribution among rural regions, increased community education on health preventative measures and health service expansion to socio-economically disadvantaged households.
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| 24. |
- Daca, Chanvo S. L., et al.
(författare)
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Socioeconomic and geographical inequalities in health care coverage in Mozambique : a repeated cross-sectional study of the 2015 and 2018 national surveys
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOver the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.ObjectiveThe present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.MethodsThe study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.ResultsThe non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.ConclusionsWe observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.
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| 25. |
- Daca, Chanvo, et al.
(författare)
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Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique : a cross-sectional study
- 2020
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking.OBJECTIVE: To investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage.METHODS: A cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest.RESULTS: The percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16-1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17-1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04-1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10-1.25), non-working women (PR = 1.09; 95% CI: 1.04-1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04-1.24) had a higher risk of not using modern contraceptives.CONCLUSION: Our study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.
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| 26. |
- Daca, Chanvo, et al.
(författare)
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Wealth inequalities in reproductive and child health preventive care in Mozambique : a decomposition analysis
- 2022
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Ingår i: Global Health Action. - : Taylor & Francis Group. - 1654-9716 .- 1654-9880. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference.Objective: To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis.Methods: Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality.Results: The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap.Conclusion: There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.
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| 27. |
- Dresse, Menayit Tamrat, et al.
(författare)
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Prevalence and factors associated with healthcare avoidance during the COVID-19 pandemic among the Sámi in Sweden : the SámiHET study
- 2023
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Ingår i: International Journal of Circumpolar Health. - : Informa UK Limited. - 1239-9736 .- 2242-3982. ; 82:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this population-based cross-sectional study was to assess the prevalence of healthcare avoidance during the COVID-19 pandemic and its associated factors among the Sámi population in Sweden. Data from the “Sámi Health on Equal Terms” (SámiHET) survey conducted in 2021 were used. Overall, 3,658 individuals constituted the analytical sample. Analysis was framed using the social determinants of health framework. The association between healthcare avoidance and several sociodemographic, material, and cultural factors was explored through log-binomial regression analyses. Sampling weights were applied in all analyses. Thirty percent of the Sámi in Sweden avoided healthcare during the COVID-19 pandemic. Sámi women (PR: 1.52, 95% CI: 1.36–1.70), young adults (PR: 1.22, 95% CI:1.05–1.47), Sámi living outside Sápmi (PR: 1.17, 95% CI: 1.03–1.34), and those having low income (PR: 1.42, 95% CI:1.19–1.68) and experiencing economic stress (PR: 1.48, 95% CI: 1.31–1.67) had a higher prevalence of healthcare avoidance. The pattern shown in this study can be useful for planning future pandemic responses, which should address healthcare avoidance, particularly among the identified vulnerable groups, including the active participation of the Sámi themselves.
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| 28. |
- Edeby, Agnes, et al.
(författare)
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Prevalence and sociogeographical inequalities of violence against women in Ecuador : a cross-sectional study
- 2021
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Violence against women (VAW) is a vast public health problem in Latin America. The aim of this study was to determine the prevalence of violence against women and to assess its sociogeographical inequalities in Ecuador during 2019.Methods: This cross-sectional study used data from a national survey conducted in 2019 (n = 17,211) among women aged 15 years and over. Independent variables included age, marital status, education, ethnicity, place of residence and region. The chosen outcomes were lifetime experience of total violence, sexual violence, physical violence, psychological violence and economic violence. Frequency tables were first calculated, and then crude and adjusted regression models estimating risk differences and their 95% confidence intervals were computed.Results: Nearly two-thirds (64.86%) of the participating women had experienced some form of violence during their lifetime, mainly psychological violence (56.92%). The second most prevalent type of violence was physical (35.44%) closely followed by sexual (32.67%). Almost one-fifth (16.38%) stated to have experienced some form of economic violence. Physical and psychological violence were more common among women aged 26–35 and less among older women. All forms of violence were more often reported among women with no education except for sexual violence, which was more frequent among those with higher education. Physical, psychological and economic violence were more often reported by those living with a partner, being married or divorced/separated. Sexual violence was associated with those belonging to a non-indigenous ethnic group, while all types of violence were more common among those living in an urban setting (except physical violence), in the Highlands or in the Amazon region.Conclusions: Our study showed that VAW is a common event in Ecuador and identified several sociogeographical inequalities that varied depending on the type of violence. VAW was more common among the younger age groups, those with low education, those living with a partner or being divorced/separated, or residing in an urban setting, in the Highlands or in the Amazon. Further studies including more social factors and a continuous monitoring of VAW are recommended. Current policies and laws to protect women need to be expanded and effectively implemented to reduce VAW in the Ecuador.
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| 29. |
- Flores Jimenez, Sergio E., et al.
(författare)
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Assessing the impact of the 2008 health reform in Ecuador on the performance of primary health care services : an interrupted time series analysis
- 2021
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage. While coverage indicators have increased, a systematic assessment of the impact of the reform on the delivery of health services at primary level is lacking. The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador.Methods: Ambulatory Care Sensitive Conditions (ACSC) are a subset of diseases where hospital admission is potentially avoidable by high quality well-functioning primary care. Thus, observing the behaviour of ACSC hospitalizations can serve as an indicator of how the primary health care level is performing. Crude and adjusted rates, stratified by sex, were calculated from ten selected ACSC hospitalization discharges during 22 years of data representing 11 years before and after the health reform. An interrupted time series analysis was then conducted by applying a negative binomial regression and adjusting for overdispersion and autocorrelation.Results: Overall higher crude and adjusted rates for ACSC hospitalizations were observed in women compared to men; both increased gradually since the start of the observation, reaching a peak around 2010, and then started a downwards trend. In men, the incidence rate ratio increased significantly by 3 % per year during the period before the intervention. During the first year after intervention, an increase (13 %) was detected, and then a statistically significant 1 % decrease (IRR = 0.99; 95 % CI: 0.98, 0.99) was observed in the ACSC rate ratio per year in the period after the intervention. Similar trends and effect sizes were found for women.Conclusions: The study revealed significant decreasing trends of the ACSC hospitalization rates in both sexes, indicating an improvement of the performance of the primary health care services following the 2008 national health reform. A continuous strengthening of the primary care model as well as a regular monitoring of ACSC hospitalization rates in the country is recommended. A health economic evaluation considering hospitalizations avoided and associated costs is also advisable.
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| 30. |
- Fonseca-Rodríguez, Osvaldo, et al.
(författare)
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Spatial clustering and contextual factors associated with hospitalisation and deaths due to COVID-19 in Sweden : A geospatial nationwide ecological study
- 2021
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 6:7
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: In Sweden, thousands of hospitalisations and deaths due to COVID-19 were reported since the pandemic started. Considering the uneven spatial distribution of those severe outcomes at the municipality level, the objective of this study was, first, to identify high-risk areas for COVID-19 hospitalisations and deaths, and second, to determine the associated contextual factors with the uneven spatial distribution of both study outcomes in Sweden.Methods: The existences of spatial autocorrelation of the standardised incidence (hospitalisations) ratio and standardised mortality ratio were investigated using Global Moran's I test. Furthermore, we applied the retrospective Poisson spatial scan statistics to identify high-risk spatial clusters. The association between the contextual demographic and socioeconomic factors and the number of hospitalisations and deaths was estimated using a quasi-Poisson generalised additive regression model.Results: Ten high-risk spatial clusters of hospitalisations and six high-risk clusters of mortality were identified in Sweden from February 2020 to October 2020. The hospitalisations and deaths were associated with three contextual variables in a multivariate model: population density (inhabitants/km 2) and the proportion of immigrants (%) showed a positive association with both outcomes, while the proportion of the population aged 65+ years (%) showed a negative association.Conclusions: Our study identified high-risk spatial clusters for hospitalisations and deaths due to COVID-19 and the association of population density, the proportion of immigrants and the proportion of people aged 65+ years with those severe outcomes. Results indicate where public health measures must be reinforced to improve sustained and future disease control and optimise the distribution of resources.
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| 31. |
- Fonseca Rodriguez, Osvaldo, PhD, 1982-, et al.
(författare)
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"The devil is in the detail": geographical inequalities of femicides in Ecuador
- 2021
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Femicide is a very important public health problem in Ecuador. Since regional and country-level femicide rates can obscure significant variations at the sub-national level, it is important to provide information at the lowest relevant level of disaggregation to be able to develop targeted preventive policies. The aim of this study was to assess the spatial distribution of the femicide rate and to examine its spatial clustering at the canton level in Ecuador in the period 2018-2019.METHODS: Data on cases were collected by a national network of non-governmental organizations. Two age-disaggregated analyses were done, one for the 15 to 24 years-olds and the other for the female population of 15 and older. Age-specific population data were obtained from the National Institute of Statistics for the study period. Standardized mortality ratios for mapping the mortality were calculated using hierarchical Bayesian models and spatial scan statistics were applied to identify local clusters. Thematic maps of age-specific femicide rates were also constructed.RESULTS: During the two-year period, 61 and 183 women were killed in the age ranges 15-24 and 15 years and older, respectively. The annual rate of femicides in Ecuador was 1.0 and 0.8 per 100,000 in the female population aged 15-24 and 15+, respectively, with substantial variations among cantons. The spatial analysis contributed to visualize high risk cantons, which were mainly located in a small area in the central part of the country (for those 15+) but especially in the Amazon region, for both of the studied age groups.CONCLUSIONS: This study has shown the usefulness of applying spatial analysis to the problem of femicides in Ecuador. The study has revealed important variations among cantons but also a spatial clustering, mainly in the Amazon region of the country. The results should help policymakers to focus on current prevention programmes for violence against women into these high-risk areas. Continuous monitoring of femicides at low-level geographical areas is highly recommended.
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| 32. |
- Gaitonde, Rakhal, et al.
(författare)
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Dissonances and disconnects : the life and times of community-bsaed accountability in the National Rural Health Mission in Tamil Nadu, India
- 2020
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There are increasing calls for developing robust processes of community-based accountability as key components of health system strengthening. However, implementation of these processes have shown mixed results over time and geography. The Community Action for Health (CAH) project was introduced as part of India’s National Rural Health Mission (now National Health Mission) to strengthen community-based accountability through community monitoring and planning. In this study we trace the implementation process of this project from its piloting, implementation and abrupt termination in the South Indian state of Tamil Nadu.Methods: We framed CAH as an innovation introduced into the health system. We use the framework on integration of innovations in complex systems developed by Atun and others. We used qualitative approaches to study the implementation. We conducted interviews among a range of individuals who were directly involved in the implementation, focusing on the policy making organizational level.Results: We uncover what we have termed “dissonances” and “disconnects” at the state level among individuals with key responsibility of implementation. By dissonances we refer to the diversity of perspective on the concept of community-based accountability and its perceived role. By disconnects we refer to the lack of spaces and processes for “sense-making” in a largely hierarchically functioning system. These constructs we believe contributes significantly to making sense of the initial uptake and the subsequent abrupt termination of the project.Conclusions: This study contributes to the overall field of policy implementation, especially the phase between the emergence on the policy agenda and its incorporation into the day to day functioning of a system. It focuses on the implementation of contested interventions like community-based accountability, in Low- and Middle-income country settings undergoing transitions in governance. It highlights the importance of “problematization” a dimension not included in most currently popular frameworks to study the uptake and spread of innovations in the health system. It points not only to the importance of diverse perspectives present among individuals at different positions in the organization, but equally importantly the need for spaces and process of collective sense-making to ensure that a contested policy intervention is integrated into a complex system.
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| 33. |
- Gaitonde, Rakhal, 1973-
(författare)
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Divergences, dissonances and disconnects : implementation of community-based accountability in India’s national rural health mission
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Accountability of health systems to the individuals and communities they serve is increasingly recognized as a key aspect in efforts at health system strengthening. This has led to a greater focus on efforts to evolve systems that enable communities to hold health systems accountable. In parallel with this change, the governance of public systems has been transformed under the influence of the neo-liberal paradigm of governance. India introduced the flagship National Rural Health Mission (presently termed the National Health Mission) in 2005, to bring about an architectural correction of the health system. One of the five key components of the mission was ‘Communitization’. This component aimed to increase the ownership of the health systems by the communities they serve. As part of this a programme called Community Action for Health (CAH) was piloted in nine states and then rolled out nationally. The implementation diverged from the originally envisaged process in different states.This PhD research aims to understand the institutional level influences that impact on the implementation of community-based accountability and governance mechanisms and the potential of integrating such processes in the public health system in India. I used qualitative methods to map out the divergences in implementation and sought to understand the reasons for these. Next, I conducted a case study of the southern state of Tamil Nadu, in which I focused on the processes within the apex administrative level of the state.In addition to mapping two dimensions along which the policy seemed to diverge, I also documented three distinct perspectives on accountability among the key actors involved in implementing CAH. Overall there were three constructs that emerged from the research: ‘Divergences’, ‘Dissonances’ and ‘Disconnects’. Divergences refer to the way in which policies and programmes shift from the original conceptualization. Dissonances points to the presence of multiple perspectives on the same concept in the same organizational setting. Disconnects represents the lack of spaces within the organization that enable processes of collective sensemaking. The emergent understanding from the research is that the divergences in policy implementation may in fact reflect a deeper level of conflict at the level of belief and perspectives in different layers of the administration. In the absence of spaces and processes to facilitate collective sense-making, it is likely that policies, even when introduced with significant commitment from policymakers at the higher administrative layers, are likely to require systematic effort to sustain.
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| 34. |
- Gustafsson, Per E, et al.
(författare)
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A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish population
- 2024
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 343
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Tidskriftsartikel (refereegranskat)abstract
- Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.
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| 35. |
- Gustafsson, Per E, et al.
(författare)
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Inequitable impact of infection : social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden.
- 2022
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 76:3, s. 261-267
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The backdrop of the ubiquitous social inequalities has increasingly come into foreground in research on the COVID-19 pandemic, but the lack of high-quality population-based studies limits our understanding of the inequitable outcomes of the disease. The present study seeks to estimate social gradients in COVID-19 hospitalisations, intensive care admissions and death by education, income and country of birth, while taking into account disparities in comorbidities.METHODS: We used a register-based retrospective open cohort design enrolling all 74 659 confirmed SARS-CoV-2-positive cases aged >25 years in Sweden during the first wave of the pandemic (until 14 September 2020). Information was retrieved from multiple registers and linked by the unique Swedish personal identity number concerning COVID-19 case identification; COVID-19 hospitalisations, intensive care admissions and death; comorbidities as measured by the Charlson Comorbidity Index; and sociodemographic information. Social gradients were estimated by the Relative Index of Inequality (RII) using Cox regression.RESULTS: Adjusted analyses showed significant social gradients in COVID-19 hospitalisation, intensive care admission, across education, income and country of birth, which were unaffected by adjustment for comorbidities. Education and country of birth gradients were stronger for hospitalisation and intensive care admissions but small to non-existent for death. In contrast, income gradients were consistent across all three COVID-19 outcomes.CONCLUSION: Social gradients in severe COVID-19 outcomes are widespread in Sweden, but appear to be unrelated to pre-existing health disparities. Inequitable outcomes of SARS-CoV-2 infection may therefore be at least partially avoidable and could rely on equitable management of confirmed COVID-19 cases.
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| 36. |
- Gustafsson, Per E, et al.
(författare)
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Intersectional inequalities in loneliness among older adults before and during the early phase of the COVID-19 pandemic : A total population survey in the Swedish eldercare setting
- 2022
-
Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347.
-
Tidskriftsartikel (refereegranskat)abstract
- Loneliness among older adults is a public health problem that has received particular attention since the emergence of the COVID-19 pandemic. Studies to date have however found a rather modest psychosocial impact of the pandemic on older adults, and scarce research has analyzed this impact using a comprehensive equity lens. The present study used an intersectional approach to examine social inequalities in loneliness before and during the early phase of the pandemic among older adults receiving eldercare in Sweden. The study population (analytical N = 205,529) came from two waves (2019 and 2020) of a total population survey to all older adult (>65 years of age) home care recipients and nursing home residents in Sweden. Loneliness was self-reported by a single-item measure, and survey data were linked to population register data on age, gender, residential setting, income, and country of birth. Additive binomial regression models were used to estimate prevalence differences and discriminatory accuracy according to an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach. Results showed inequalities in loneliness arising particularly in the intersection of country of birth, income, and residential setting. The inequalities widened slightly but ubiquitously following the emergence of the pandemic in 2020, with particularly nursing home residents emerging as a risk group. The discriminatory accuracy of inequalities was consistently low to moderate throughout the analyses but increased marginally during the pandemic in 2020. The study illustrates how social inequalities engenders heterogeneity in the psychosocial risk of older adults before and during the pandemic. These findings should stimulate more nuanced and equity-oriented depictions, research and policies about loneliness among older adults in the peri-pandemic era.
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| 37. |
- Gustafsson, Per E., et al.
(författare)
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Surviving through solitude: A prospective national study of the impact of the early COVID-19 pandemic and a visiting ban on loneliness among nursing home residents in Sweden
- 2022
-
Ingår i: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press. - 1079-5014 .- 1758-5368. ; 77:12, s. 2286-2295
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Targeted social distancing measures were widely implemented for nursing home residents when the extremely high coronavirus disease 2019 mortality in this setting became apparent. However, there is still scarce rigorous research examining how the pandemic and accompanying social distancing measures affected loneliness in this group. This prospective nationwide Swedish study of nursing home residents aimed to examine the impact on loneliness of the early phase of the pandemic and of a national visiting ban at nursing homes.Methods: A panel was selected from a total population survey of all nursing home residents in Sweden March–May 2019 and 2020 (N = 11,782; age range 70–110 years; mean age 88.2 years; 71% women). Prospective pretest–posttest and controlled interrupted time series (ITS) designs were employed, with time trends estimated by date of returned questionnaire. Generalized linear models were used for estimation of effects, adjusting for demographic-, survey-, and health-related covariates.Results: Loneliness prevalence increased from 17% to 19% from 2019 to 2020 (risk ratio, RR (95% confidence interval, CI) = 1.104 (1.060; 1.150)), but which was explained by self-reported health (RR (95% CI) = 1.023 (0.982; 1.066)). No additional impact of the visiting ban on loneliness trends was found in the ITS analyses (RR (95% CI) = 0.984 (0.961; 1.008)).Discussion: The moderate but health-dependent increased risk of loneliness, and the lack of impact of the nationwide visiting ban at nursing homes, suggests that this ostensibly vulnerable group of nursing home residents also shows signs of resilience, at least during the early phase of the pandemic.
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| 38. |
- Gustafsson, Per E., et al.
(författare)
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Venerable vulnerability or remarkable resilience? : A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine the early impact of the pandemic and of quarantine measures targeting older adults introduced in March 2020 on loneliness among older adults in Sweden.Design: Prospective pretest-posttest and controlled interrupted time series designs.Setting: The population of older adults receiving home care before and during the emergence of the first COVID-19 pandemic wave in Sweden in Spring 2020.Participants: Respondents (n=45 123, mean age 85.6 years, 67.6% women) came from two waves of a total population survey targeting all community-dwelling older adults receiving home care for older adults in Sweden in Spring 2019 and 2020.Outcome: Self-reported loneliness.Results: Results estimated 14% (95% CI: 10 to 19) higher loneliness in Spring 2020 compared with 2019, taking covariates into account. No impact of the quarantine measure was found (1% increase, 95% CI: -1 to 4).Conclusions: The results illustrate the broader public health consequences of the COVID-19 pandemic for older adults, but also suggest a relative resilience among older adults in home care to quarantine measures, at least during the first months of the pandemic. Future studies should examine the long-term effects of sustained pandemic and social distancing measures on loneliness among older adults.
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| 39. |
- Healey Akearok, Gwen K., et al.
(författare)
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Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic
- 2024
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Ingår i: International Journal of Circumpolar Health. - : Taylor & Francis Group. - 1239-9736 .- 2242-3982. ; 83:1
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Tidskriftsartikel (refereegranskat)abstract
- This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.
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| 40. |
- Hernández, Alison, et al.
(författare)
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Building collective power in citizen-led initiatives for health accountability in Guatemala : the role of networks
- 2020
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Ingår i: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Citizen-led accountability initiatives are a critical strategy for redressing the causes of health inequalities and promoting better health system governance. A growing body of evidence points to the need for putting power relations at the forefront of understanding and operationalizing citizen-led accountability, rather than technical tools and best practices. In this study, we apply a network lens to the question of how initiatives build collective power to redress health system failures affecting marginalized communities in three municipalities in Guatemala.Methods: Network mapping and interpretive discussions were used to examine relational qualities of citizen-led initiatives’ networks and explore the resources they offer for mobilizing action and influencing health accountability. Participants in the municipal-level initiatives responded to a social network analysis questionnaire focused on their ties of communication and collaboration with other initiative participants and their interactions with authorities regarding health system problems. Discussions with participants about the maps generated enriched our view of what the ties represented and their history of collective action and also provided space for planning action to strengthen their networks.Results: Our findings indicate that network qualities like cohesiveness and centralization reflected the initiative participants’ agency in adapting to their sociopolitical context, and participants’ social positions were a key resource in providing connection to a broad base of support for mobilizing collective action to document health service deficiencies and advocate for solutions. Their legitimacy as “representatives of the people” enabled them to engage with authorities from a bolstered position of power, and their iterative interactions with authorities further contributed to develop their advocacy capabilities and resulted in accountability gains.Conclusions: Our study provided evidence to counter the tendency to underestimate the assets and capabilities that marginalized citizens have for building power, and affirmed the idea that best-fit, with-the-grain approaches are well-suited for highly unequal settings characterized by weak governance. Efforts to support and understand change processes in citizen-led initiatives should include focus on adaptive network building to enable contextually-embedded approaches that leverage the collective power of the users of health services and grassroots leaders on the frontlines of accountability.
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| 41. |
- Hernandez, Alison, et al.
(författare)
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'History obligates us to do it' : political capabilities of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala
- 2022
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Growing interest in how marginalised citizens can leverage countervailing power to make health systems more inclusive and equitable points to the need for politicised frameworks for examining bottom-up accountability initiatives. This study explores how political capabilities are manifested in the actions and strategies of Indigenous grassroots leaders of health accountability initiatives in rural Guatemala. Qualitative data were gathered through group discussions and interviews with initiative leaders (called defenders of the right to health) and initiative collaborators in three municipalities. Analysis was oriented by three dimensions of political capabilities proposed for evaluating the longer-term value of participatory development initiatives: political learning, reshaping networks and patterns of representation. Our findings indicated that the defenders' political learning began with actionable knowledge about defending the right to health and citizen participation. The defenders used their understanding of local norms to build trust with remote Indigenous communities and influence them to participate in monitoring to attempt to hold the state accountable for the discriminatory and deficient healthcare they received. Network reshaping was focused on broadening their base of support. Their leadership strategies enabled them to work with other grassroots leaders and access resources that would expand their reach in collective action and lend them more influence representing their problems beyond the local level. Patterns of representing their interests with a range of local and regional authorities indicated they had gained confidence and credibility through their evolving capability to navigate the political landscape and seek the right authority based on the situation. Our results affirm the critical importance of sustained, long-term processes of engagement with marginalised communities and representatives of the state to enable grassroots leaders of accountability initiatives to develop the capabilities needed to mobilise collective action, shift the terms of interaction with the state and build more equitable health systems.
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| 42. |
- La Parra-Casado, Daniel, et al.
(författare)
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Ethnic discrimination and mental health in the Sámi population in Sweden : the SámiHET study
- 2024
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 52:4, s. 442-449
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To assess the association between experiences of discrimination and mental health among the Sámi population in Sweden.Methods: Cross-sectional study among the self-identified Sámi population living in Sweden in 2021, registered in the electoral roll of the Sámi Parliament, the reindeer mark register and the ‘Labour statistics based on administrative sources’. The analysis was based on a final sample of 3658 respondents aged between 18 and 84 years. Adjusted prevalence ratios aPRs for psychological distress (Kessler scale), self-reported anxiety and depression were estimated for four different forms of discrimination (direct experience of discrimination, offended because of ethnicity, historical trauma, and combined discrimination).Results: Higher aPRs of psychological distress, anxiety and depression were observed in women experiencing direct discrimination because of their ethnicity, having been offended because of their ethnicity, and those with a family history of discrimination. Among men, higher aPRs for psychological distress were observed in those experiencing the four different forms of discrimination, but not for anxiety. Depression was only detected in the case of having been offended. Adding experiences of discrimination was associated with a higher prevalence of negative outcomes for all the indicators in women and for psychological distress in men.Conclusions: The observed association between experiences of discrimination and mental health problems would support a gender approach when considering ethnic discrimination in public health policies concerning the Sámi in Sweden.
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| 43. |
- Mamani-Ortiz, Yercin, 1985-
(författare)
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Cardiovascular disease prevention in Cochabamba, Bolivia : the importance of preventable risk factor distribution and inequalities for policy implementation
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The increase in the prevalence of cardiovascular diseases (CVDs) and cardiovascular risk factors (CVRFs) is considered one of the most important public health problems in Latin American (LA) countries. Accordingly, an accurate and comprehensive picture of the CVRFs situation is needed to prevent CVDs and consequently support the development of health policies to improve population health and reduce health inequalities. Objective: To estimate the distribution of CVRFs and to examine social inequalities in these factors in Cochabamba – Bolivia to provide useful information for public health practice and decision-making. Methods: This thesis is based on four studies that used quantitative and qualitative methods. For sub-studies 1, 2, and 3, the data collection procedure was based on the Pan-American version (V2.0) of the WHO STEPS approach adapted to the Bolivian context. Between 2015 and 2016; 10,754 individuals aged over 18 years old were surveyed. To sub-study 1, the prevalence of relevant behavioural risk factors and anthropometric measures were calculated, and then odds ratios were estimated for each CVRFs. Regarding sub-study 2, an intersectionality approach based on the method suggested by Jackson et al. was used to analyze the ethnic and gender inequalities in obesity followed by the Oaxaca-Blinder decomposition to estimate the contributions of explanatory factors underlying the observed intersectional disparities. For sub-study 3, bivariate and multivariable regression analyses were carried out to analyze the association between access to CVDs healthcare and to preventive activities for CVRFs, with demographic and socioeconomic factors, and healthcare needs. Finally, to sub-study 4, in-depth interviews were conducted among 14 key informants focusing on aspects related to the implementation process of the CVDs policy. The interviews were recorded, transcribed verbatim, and analyzed using reflexive thematic analysis.Main findings: Our findings revealed that Cochabamba had a high prevalence of CVRFs, with significant variations among the different socio-demographic groups. Indigenous populations and those living in the Andean region showed, in general, a lower prevalence for most of the risk factors studied. The prevalence of the metabolic risk factors were: overweight (35.84%); obesity (20.49%); abdominal obesity (54.13%); and raised blood pressure (17.5%). It is important to highlight that 40.7% of participants had four or more CVRFs simultaneously.Dually and singly disadvantaged groups (Indigenous women, Indigenous men, and mestizo women) were less obese than the dually advantaged group (mestizo men). The joint disparity showed that the obesity prevalence was 7.26 percentage points higher in the doubly advantaged mestizo men than in the doubly disadvantaged Indigenous women. The lower prevalence of obesity in the doubly disadvantaged group of Indigenous women was mainly due to ethnic differences alone. Health behaviours were important factors in explaining the intersectional inequalities, while differences in socioeconomic and demographic factors played a less important role.The analysis also suggested a horizontal inequity in education, job status, region, and health insurance ownership regarding access to healthcare for CVDs and preventive activities for CVRFs. In the case of healthcare access, a lower probability of accessing healthcare for those with no formal education (OR=0.63; 95% CI=0.49-0.82) compared to those with higher education was found. Participation in preventive activities was significantly less among those with low educational levels, with the lowest participation observed in people with no formal education (OR=0.51; 95% CI=0.40-0.63). Individuals who were retired (OR=0.72; 95% CI=0.53-0.99), and those living in the Andean (OR=0.51; 95% CI=0.44-0.60) and Southern cone (OR=0.53; 95% CI=0.45-0.64) also displayed lower odds of participation. The challenges highlighted for the implementation of the CVDs policy in the Bolivian primary healthcare system were: the importance of i) local research, ii) a functional surveillance system, iii) effective leadership and coordination, iv) investments in municipal and community-level initiatives, and v) the need for health personnel capacity building. Conclusion: The prevalence of all CVRFs in Cochabamba was high, and nearly two-thirds of the population reported four or more risk factors simultaneously. The intersectional disparities illustrate that abdominal obesity was not distributed according to expected patterns of structural disadvantages in the intersectional spaces of ethnicity and gender in Bolivia. While vertical equity was observed in access to healthcare and in the participation of preventive activities, a horizontal inequity regarding education, region, and health insurance ownership was found. In addition, our findings highlighted five main challenges in the implementation of the CVDs policy in the Bolivian primary healthcare system; including local research; a functional surveillance system; leadership and governance; investment in municipal and community-level; and Health personnel for the implementation of CVD policy and its prevention strategies. The information generated by this study provides evidence for health policymakers at the regional level to carry out specific interventions to prevent CVDRFs both at the population and at the individual level. It is important to understand the contribution of socioeconomic factors and health needs in the process of formulating strategies that seek to reduce inequalities in access to healthcare in Cochabamba and nationally.
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| 44. |
- Mangemba, Nancy T., et al.
(författare)
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Societal risk factors for overweight and obesity in women in Zimbabwe : a cross-sectional study
- 2020
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overweight and obesity are well-recognized risk factors for various non-communicable diseases. Evidence shows an increasing burden of overweight and obesity in low and middle-income countries, especially in women. Little is known about the risk factors in Zimbabwe. The aim of this study was to determine the socioeconomic risk factors for overweight and obesity in non-pregnant adult Zimbabwean women.Methods: A cross-sectional study was conducted using the 2015 Zimbabwe Demographic Health Survey (n = 8904) data on the adult female population aged 15 to 49. Body mass index (BMI) was calculated by dividing the body weight by height squared. The socio-economic variables studied were age, marital status, residence, province, religion, education, household wealth index, household size, access to mass media and the use of contraception. Prevalence of overweight (BMI >= 25-29.9 kg/m(2)) and obesity (BMI >= 30 kg/m(2)) were determined. Simple and multivariable logistic regressions were then used to ascertain any relationships.Results: The weighted prevalence of overweight and obesity in adult females was 34.2 and 12.3% respectively. The odds for being overweight and obese were significantly higher with increasing age (Adjusted Odds Ratio (AOR 2.76, 95% CI:2.45-3.11 for overweight and AOR 3.24, 95% CI:2.69-3.90 for obesity) with marriage (AOR 1.58, 95% CI:1.38-1.79 for overweight and AOR 1.54, 95% CI:1.27-1.87 for obesity), high wealth status (AOR 4.01, 95% CI:2.93-5.50 for overweight and AOR 6.97, 95% CI:4.08-11.9 for obesity), and the use of hormonal contraception (AOR 1.24, 95% CI:1.07-1.41 for overweight and AOR 1.35, 95% CI:1.10-1.64 for obesity). Additionally, having higher education increased the odds of being obese (AOR 1.44, 95% CI:1.07-1.96) while being Christian increased the odds for being overweight (AOR 1.13, 95% CI:1.00-1.28).Conclusions: The prevalence of overweight and obesity among women in Zimbabwe was high. The key social factors associated were older age, being married, being wealthy and the use of hormonal contraception. Having a higher education and being Christian also increased the risk of being obese and overweight respectively. The design of multi-faceted overweight and obesity reduction programs for women that focus on increasing physical activity and strengthening of social support systems are necessary to combat this epidemic.
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| 45. |
- Mathias, Kaaren, et al.
(författare)
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The effectiveness of a multi-pronged psycho-social intervention among people with mental health and epilepsy problems : a pre-post prospective cohort study set in North India
- 2021
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Ingår i: International Journal of Health Policy and Management. - : Kerman University of Medical Sciences. - 2322-5939. ; 10:9, s. 546-553
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Tidskriftsartikel (refereegranskat)abstract
- Background: In low-and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy.Methods: In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients.Results: Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B =-6.94, 95% CI-7.37 to-6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B =-4.86, 95% CI-7.14 to-2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B =-5.22, 95% CI-7.29 to-3.15).Conclusion: This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was non-pharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.
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| 46. |
- Mosquera, Paola A., et al.
(författare)
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Performing Through Privatization : An Ecological Natural Experiment of the Impact of the Swedish Free Choice Reform on Ambulatory Care Sensitive Conditions
- 2021
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Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance.Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001–2009 (pre-intervention period) and 2010–2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform.Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC.Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests that high degree of private provision may involve worse performance and higher care burden for specialized health care. Further evaluations of the consequences of the reform are dire needed to provide a comprehensive picture of its intended and unintended impact on health care provision, delivery and results.
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| 47. |
- Nilsson, Lena Maria, 1965-, et al.
(författare)
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The health experience of the COVID-19 pandemic among the Sámi in Sweden : a cross-sectional comparative study
- 2023
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Ingår i: The Arctic Yearbook. - : Thematic Network (TN) on Geopolitics and Security of the University of the Arctic. - 2298-2418. ; , s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- There is an international concern that the COVID-19 pandemic could have had serious effects on Indigenous peoples’ livelihoods and health. To our knowledge, no research has been published regarding the impact of COVID-19 on the lives of the Sámi people. The aim of this study is to assess the health care and social experience of the pre-vaccine phase of the COVID-19 pandemic among the Sámi, in comparison with the national population, in Sweden.Two population-based surveys, in the Sámi and the Swedish populations, were conducted between February and May 2021. In addition to sociodemographic and health information, a questionnaire regarding the health experience of COVID-19 designed by the Public Health Agency of Sweden was included. Both surveys targeted individuals aged 18–84 years and the participation rate was 40.9% in the Sámi study and 44.3% in the national study.Based on the data collected, Sámi in Sweden seem to have been affected in a similar or even in a milder way than the national population during the pre-vaccine phase of the COVID-19 pandemic. Further studies are needed to explore the distribution of these outcomes among different Sámi subgroups. Register studies are also needed to evaluate the clinical (morbidity and mortality) impact of COVID-19 in the Sámi population.
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| 48. |
- Nyamande, Fortune N., et al.
(författare)
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Intersectional equity in health care : assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden
- 2020
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach.METHODS: Data on participants (N = 22,997) aged 16-84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization.RESULTS: Joint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40-9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67-5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56-6.19), but with no significant horizontal inequity - by gender, education, or their combination - remaining after needs adjustment.CONCLUSION: This study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.
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| 49. |
- Pat, Puthy, et al.
(författare)
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Mental health problems and suicidal expressions among young male prisoners in Cambodia : a cross-sectional study
- 2021
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incarceration and mental health problems are known to have a strong empirical association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none has been conducted in Cambodia.Objectives: This study aimed to assess the level of mental health problems and suicidal expressions, and determine the associated risk factors among young prisoners in Cambodia.Method: This was a cross-sectional study among 572 young prisoners between the ages of 15 and 24 from three prisons. Sociodemographic data and detailed information on participants’ profiles were gathered, and mental health problems and suicidal expressions were assessed using the Youth Self-Report (YSR) and the Attitude Towards Suicide (ATTS) questionnaires, respectively.Results: Mental health problems as revealed by the mean YSR scores were: 25.97 for internalizing and 18.12 for externalizing problems; 11.88 for anxiety/depression, 9.97 for aggressive behaviours and 7.53 for somatic complaints. Social problems, attention problems and rule breaking behaviour were in the range of 8.10 to 8.49. Withdrawal depression and thought problems mean scores were 6.55 and 6.66, respectively. Mental health problems were associated with younger age, lower educational background, and shorter duration of incarceration. Around 16% had thought about their own death, and 12% expressed wish to die. Suicide ideation, planning, and attempts were reported by almost 7%, 2%, and 3% of participants respectively. Prior drugs users thought about death significantly more than their counterparts while suicide ideation was significantly lower among prisoners with higher education.Conclusion: Mental health problems and suicidal expressions among young prisoners warrant well-planned mental health services that are integrated into the current prison health system. A contextualised intervention that takes into account age, education, duration of incarceration and previous drug use may contribute to improve the mental well-being of young prisoners in Cambodia.
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| 50. |
- Pat, Puthy, et al.
(författare)
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“Overcrowded but lonely” : exploring mental health and well-being among young prisoners in Cambodia
- 2023
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Ingår i: International Journal of Prisoner Health. - : Emerald Group Publishing Limited. - 1744-9200 .- 1744-9219. ; 19:4, s. 628-640
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Young prisoners are one of the most vulnerable groups in society for mental health problems and ill-being. Therefore, there is a crucial need to understand their physical, psychological and social situations. This study aims to explore young Cambodian prisoners’ experiences and perceptions of mental health and well-being, their determinants and their coping strategies.Design/methodology/approach – Six focus group discussions were carried out in three prisons with atotal of 48 young prisoners between the ages of 15 and 24 years (50% women, 50% men). Semistructured questions guided the discussions, and thematic analysis was applied to analyse the data.Findings – Young prisoners reported multifaceted experiences of mental health and well-being. The majority described adverse mental health experiences, while some revealed better well-being, partlyinfluenced by the socio-economic support from outside the prisons and previous involvement or not indrug abuse. The experience of physical overcrowding without emotional attachment among the fellow prisoners was perceived as the overarching determinant of loneliness and mental health problems, while socio-emotional support and rituals were described as the most important coping mechanisms.Originality/value – This pioneering study from Cambodia gives young prisoners an opportunity to voice their experiences and perceptions of mental health and well-being in the prison setting. The findings inthis study underline the importance of prison authorities tackling overcrowding to promote well-being andreduce mental health problems. Also, the coping mechanisms outlined by the participants should be considered when planning psychosocial interventions.
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