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  • 201. Cochran, Susan D.
    et al.
    Björkenstam, Charlotte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. University of California, Los Angeles, USA.
    Mays, Vickie M.
    Sexual Orientation Differences in Functional Limitations, Disability, and Mental Health Services Use: Results From the 2013-2014 National Health Interview Survey2017Ingår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 85, nr 12, s. 1111-1121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013-2014 National Health Interview Survey. Method: Respondents were 68,816 adults (67,152 heterosexual and 1,664 lesbian, gay, and bisexual [LGB] individuals), age 18 and older. Fully structured interviews assessed sexual orientation identity, health status, and services use. Using sex-stratified analyses while adjusting for demographic confounding, the authors compared LGB and heterosexual individuals for evidence of mental health-related impairments and use of mental health services. Results: LGB adults, as compared to heterosexual adults, demonstrated higher prevalence of mental health morbidity and functional limitations. However, this varied by gender with LGB women evidencing elevated risk for both mental health and substance abuse (MHSA) and non-MHSA limitations. Among men, sexual orientation differences clustered among MHSA-related limitations. Overall, LGB adults were more likely than heterosexual adults to use services, with the source of functional limitations moderating these effects among men. Conclusion: MHSA-related morbidity is a significant concern among LGB individuals and is associated with higher levels of functional limitations/disability. The findings highlight that LGB persons use MHSA-related treatment at higher rates than heterosexuals do, and, among men, are more likely to do so absent MHSA or non-MHSA-related functional limitations. This presents a unique set of concerns within the integrated care setting, including the need to deliver culturally competent care sensitive to the context of probable sex differences among LGB individuals.

  • 202.
    Dahlberg, Lena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Dalarna University, Sweden.
    Andersson, Lars
    Lennartsson, Carin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Long-term predictors of loneliness in old age: results of a 20-year national study2018Ingår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, nr 2, s. 190-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The understanding of social phenomena is enhanced if individuals can be studied over longer periods. Regarding loneliness in old age, there is a general lack of longitudinal research. The aim of this study was to examine whether there is an association between loneliness in old age and social engagement 20years earlier, as stated by life course theory and the convoy model.

    Method: Data from the nationally representative Swedish Panel Study of Living Conditions of the Oldest Old (2002 and 2011 data collection waves) and the Swedish Level of Living Survey (1981 and 1991 data collection waves) were used. The sample included 823 individuals with an average age of 62.2years at baseline and 82.4years at follow-up.

    Results: Each form of social engagement in old age was significantly associated with the same form of social engagement 20years earlier. Close forms of social engagement were associated with loneliness in old age; as were more distant forms of social engagement, but only when they were considered solely in old age.

    Conclusion: Patterns of social engagement in old age were established at least 20years earlier and close forms of social engagement are long-term predictors of loneliness, although current social engagement tended to be more influential on loneliness. The study underlines the importance of interventions targeted at close relationships that can provide social support in old age.

  • 203.
    Dahlqvist, Mattias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Is family structure associated with the psychological behavior of young people?: The Strengths and Difficulties Questionnaire in a population sample2016Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Differences in family structure have been linked to several mental health outcomes, where children living in a nuclear family setting are best-off, while children in joint physical custody are second best followed by those living mostly and only with one parent. One of the biggest changes in recent years is that joint physical custody is growing more common. The dependent variables in this thesis were three dimensions of mental health from the Strengths and Difficulties Questionnaire. Data from 6th and 9th graders in the entire Sweden 2009 was used. Regression modelling showed differences in mental health between the family structures throughout, although children in  joint physical custody was not significantly different from those in nuclear families (reference category) in half of the models. Children living mostly with one parent reported the third worst levels of problematic behaviour and prevalence of low prosocial behaviour while those living with just one parent were worst off. Stratifying by gender did reveal small coefficient differences and so did controls for birth region. This thesis, although in a line of other publications based on this study can help shape future guidelines for e.g. social workers.

  • 204. Dams, Judith
    et al.
    Buchholz, Angela
    Kraus, Ludwig
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. IFT Institute for Therapeutic Research Munich, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Scherbaum, Norbert
    Konnopka, Alexander
    König, Hans-Helmut
    Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 8, artikel-id e020563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. Design In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. Settings Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). Participants n=236adult patients with alcohol dependence and n=4687adult individuals without alcohol dependence. Primary and secondary outcome measures The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. Results Total 6-month excess costs of Euro11839 (95% CI Euro11 529 to Euro12 147) were caused by direct excess costs of Euro4349 (95% CI Euro4129 to Euro4566) and indirect costs of Euro7490 (95% CI Euro5124 to Euro9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. Conclusions Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. Trial registration number DRKS00005035.

  • 205. Danaei, Goodarz
    et al.
    Farzadfar, Farshad
    Kelishadi, Roya
    Rashidian, Arash
    Rouhani, Omid M.
    Ahmadnia, Shirin
    Ahmadvand, Alireza
    Arabi, Mandana
    Ardalan, Ali
    Arhami, Mohammad
    Azizi, Mohammad Hossein
    Bahadori, Moslem
    Baumgartner, Jill
    Beheshtian, Arash
    Djalalinia, Shirin
    Doshmangir, Leila
    Haghdoost, Ali Akbar
    Haghshenas, Rosa
    Hosseinpoor, Ahmad Reza
    Islami, Farhad
    Kamangar, Farin
    Khalili, Davood
    Madani, Kaveh
    Stockholms universitet, Naturvetenskapliga fakulteten, Institutionen för naturgeografi. Imperial College London, UK.
    Masoumi-Asl, Hossein
    Mazyaki, Ali
    Mirchi, Ali
    Moradi, Ehsan
    Nayernouri, Touraj
    Niemeier, Debbie
    Omidvari, Amir-Houshang
    Peykari, Niloofar
    Pishgar, Farhad
    Qorbani, Mostafa
    Rahimi, Kazem
    Rahimi-Movaghar, Afarin
    Tehrani, Fahimeh Ramezani
    Rezaei, Nazila
    Shahraz, Saeid
    Takian, Amirhossein
    Tootee, Ali
    Ezzati, Majid
    Jamshidi, Hamid Reza
    Larijani, Bagher
    Majdzadeh, Reza
    Malekzadeh, Reza
    Iran in transition2019Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, nr 10184, s. 1984-2005Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.

  • 206. Danielson, M.
    et al.
    Månsdotter, A.
    Fransson, Emma
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS). Karolinska Institutet, Sweden.
    Dalsgaard, S.
    Larsson, J.-O.
    Clinicians' attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry2019Ingår i: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 13, artikel-id 9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians' attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning.

    Methods: 411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions.

    Results: Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups.

    Conclusion: The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.

  • 207. Danielsson, Bengt
    et al.
    Collin, Julius
    Jonasdottir Bergman, Gudrun
    Borg, Natalia
    Salmi, Peter
    Fastbom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). National Board of Health and Welfare, Stockholm.
    Antidepressants and antipsychotics classified with torsades de pointes arrhythmia risk and mortality in older adults - a Swedish nationwide study2016Ingår i: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 81, nr 4, s. 773-783Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimThe aim of the study was to examine mortality risk associated with use of antidepressants and antipsychotics classified with torsades de pointes (TdP) risk in elderly. MethodsA matched case-control register study was conducted in people 65 years and older dying outside hospital from 2008-2013 (n=286092) and matched controls (n=1430460). The association between prescription of antidepressants and antipsychotics with various TdP risk according to CredibleMeds () and all-cause mortality was studied by multivariate conditional logistic regression adjusted for comorbidity and several other confounders. ResultsUse of antidepressants classified with known or possible TdP risk, was associated with higher adjusted risk for mortality (OR 1.53, 95% CI 1.51, 1.56 and OR 1.63, 95% CI 1.61, 1.67, respectively) compared with antidepressants classified with conditional TdP risk (OR 1.25, 95% CI 1.22, 1.28) or without TdP classification (OR 0.99, 95% CI 0.94, 1.05). Antipsychotics classified with known TdP risk were associated with higher risk (OR 4.57, 95% CI 4.37, 4.78) than antipsychotics with possible risk (OR 2.58, 95% CI 2.52, 2.64) or without TdP classification (OR 2.14, 95% CI 2.03, 2.65). The following risk ranking was observed for commonly used antidepressants: mirtazapine > citalopram > sertraline > amitriptyline and for antipsychotics: haloperidol > risperidone >olanzapine > quetiapine. ConclusionThe CredibleMeds system predicted drug-associated risk for mortality in the elderly at the risk class level. Among antipsychotics, haloperidol, and among antidepressants, mirtazapine and citalopram, were associated with the highest risks. The results suggest that the TdP risk with antidepressants and antipsychotics should be taken into consideration when prescribing to the elderly.

  • 208.
    Darin-Mattsson, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Andel, Ross
    Celeste, Roger Keller
    Kåreholt, Ingemar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Jönköping University, Sweden.
    Linking financial hardship throughout the life-course with psychological distress in old age: Sensitive period, accumulation of risks, and chain of risks hypotheses2018Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 201, s. 111-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The primary objective was to investigate the life course hypotheses - sensitive period, chain of risks, and accumulation of risks - in relation to financial hardship and psychological distress in old age. We used two Swedish longitudinal surveys based on nationally representative samples. The first survey includes people 18-75 years old with multiple waves, the second survey is a longitudinal continuation, including people 76 + years old. The analytical sample included 2990 people at baseline. Financial hardship was assessed in childhood (retrospectively), at the mean ages of 54, 61, 70, and 81 years. Psychological distress (self-reported anxiety and depressive symptoms) was assessed at the same ages. Path analysis with WLSMV estimation was used. There was a direct path from financial hardship in childhood to psychological distress at age 70 (0.26, p = 0.002). Financial hardship in childhood was associated with increased risk of psychological distress and financial hardship both at baseline (age 54), and later. Financial hardship, beyond childhood, was not independently associated with psychological distress at age 81. Higher levels of education and employment decreased the negative effects of financial hardship in childhood on the risk of psychological distress and financial hardship later on. There was a bi-directional relationship between psychological distress and financial hardship; support for health selection was slightly higher than for social causation. We found that psychological distress in old age was affected by financial hardship in childhood through a chain of risks that included psychological distress earlier in life. In addition, financial hardship in childhood seemed to directly affect psychological distress in old age, independent of other measured circumstances (i.e., chains of risks). Education and employment could decrease the effect of an adverse financial situation in childhood on later-life psychological distress. We did not find support for accumulation of risks when including tests of all hypotheses in the same model.

  • 209.
    Darin-Mattsson, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fors, Stefan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Kåreholt, Ingemar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Jönköping University, Sweden.
    Different indicators of socioeconomic status and their relative importance as determinants of health in old age2017Ingår i: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, artikel-id 173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age.

    Methods

    We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress.

    Results

    All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%.

    Conclusions

    Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided.

  • 210. Dauber, Hanna
    et al.
    Braun, Barbara
    Pfeiffer-Gerschel, Tim
    Kraus, Ludwig
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pogarell, Oliver
    Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany2018Ingår i: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882, Vol. 16, nr 1, s. 66-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System (N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.

  • 211.
    de los Reyes, Paulina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Ekonomisk-historiska institutionen.
    Working life inequalities: do we need intersectionality?2017Ingår i: Society, health and vulnerability, E-ISSN 2002-1518, Vol. 8, artikel-id UNSP 1332858Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evidence shows persistent inequalities between women and men regarding working conditions, wage levels, work time, work environment, and career opportunities. At the same time, research results show that inequality in the workplace is not only about gender differences. The specific conditions of oppression built on the simultaneous operation of class, race, and gender relations of power goes beyond the simple dichotomies involved in traditional class analysis or gender studies. Age, nationality, race, sexual preferences, bodily impairment, and class background are crucial factors in the opportunities and obstacles that people face at work. In this article, I discuss how an intersectional perspective can deepen our understanding of the informal hierarchies that create and preserve work life inequalities. Drawing on postcolonial theories and feminist perspectives on labour, I argue that the significance of an intersectional analysis is not primarily about the discrimination mechanisms based on intersecting forms of oppression. Rather, I see the potential of intersectionality in a critical interrogation of the shaping of different perceptions of labour emerging in current models of capitalist accumulation.

  • 212. de-Graft Aikins, Ama
    et al.
    Wikler, Dan
    Allotey, Pascale
    Beisel, Uli
    Cooper, Melinda
    Eyal, Nir
    Hausman, Dan
    Lutz, Wolfgang
    Norheim, Ole F.
    Roberts, Elisabeth
    Vågerö, Denny
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Jebari, Karim
    Global Health and the Changing Contours of Human Life2018Ingår i: Rethinking Society for the 21st Century: Report of the International Panel on Social Progress: Volume 3: Transformations in Values, Norms, Cultures, Cambridge: Cambridge University Press, 2018, s. 713-752Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    The contours of human life – birth, childhood, maturity, reproduction, the experiences of health, illness, and disability, and death – have been and will remain nearly universal; but their duration and texture are undergoing great changes. In this chapter, we chart the transformations and make projections into the near future. Many of the trends are favorable: fewer children are dying, and many enjoy greater longevity. But these advances are not distributed uniformly among and within countries and regions. Furthermore, the value of longevity is compromised by an increasing number of people living with diminished health under inequitable systems of health and social care. A more just future can be achieved by a continuing emphasis on equity in global health systems even as human lives continue to be extended and enhanced.

  • 213. Dekhtyar, Serhiy
    et al.
    Wang, Hui-Xin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Zhengzhou University, China.
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Herlitz, Agneta
    Childhood school performance, education and occupational complexity: a life-course study of dementia in the Kungsholmen Project2016Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, nr 4, s. 1207-1215Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cognitive reserve hypothesis predicts that intellectually demanding activities over the life course protect against dementia. We investigate if childhood school performance remains associated with dementia once education and occupational complexity are taken into account. Methods: A cohort of 440 individuals aged 75+ from the Kungsholmen Project was followed up for 9 years to detect dementia. To measure early-life contributors to reserve, we used grades at age 9-10 extracted from the school archives. Data on formal education and occupational complexity were collected at baseline and first follow-up. Dementia was ascertained through comprehensive clinical examination. Cox models estimated the relationship between life-course cognitive reserve measures and dementia. Results: Dementia risk was elevated [hazard ratio (HR): 1.54, 95% confidence interval (CI): 1.03 to 2.29] in individuals with low early-life school grades after adjustment for formal educational attainment and occupational complexity. Secondary education was associated with a lower risk of dementia (HR: 0.72, 95% CI: 0.50 to 1.03), although the effects of post-secondary and university degrees were indistinguishable from baseline. Occupational complexity with data and things was not related to dementia. However, an association was found between high occupational complexity with people and dementia, albeit only in women (HR: 0.39, 95% CI: 0.14 to 0.99). The pattern of results remained unchanged after adjustment for genetic susceptibility, comorbidities and depressive symptoms. Conclusion: Low early-life school performance is associated with an elevated risk of dementia, independent of subsequent educational and occupational attainment.

  • 214. Dekhtyar, Serhiy
    et al.
    Wang, Hui-Xin
    Scott, Kirk
    Goodman, Anna
    Koupil, Ilona
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Herlitz, Agneta
    A life-course study of cognitive reserve in dementia from childhood to old age2015Ingår i: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 23, nr 9, s. 885-896Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To test a life-course model of cognitive reserve in dementia and examine if school grades around age 10 years, formal educational attainment, and lifetime occupational complexity affect the risk of dementia in old age. Methods: 7,574 men and women from the Uppsala Birth Cohort Multigenerational Study were followed for 21 years. Information on school performance, formal education, and occupational attainment was collected prospectively from elementary school archives and population censuses. Dementia diagnosis was extracted from the two Swedish registers. Discrete-time Cox proportional hazard models were estimated. Results: Dementia was diagnosed in 950 individuals (12.5%). Dementia risk was lower among individuals with higher childhood school grades (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.68 to 0.93) and was lower among individuals in data-complex occupations (HR: 0.77; 95% CI: 0.64 to 0.92). Professional/university education predicted lower risk of dementia in minimally adjusted models (HR: 0.74; 95% CI: 0.60 to 0.91), although the effect faded with adjustment for occupational complexity. Lowest risk was found in the group with both higher childhood school performance and high occupational complexity with data (HR: 0.61; 95% CI: 0.50 to 0.75). Importantly, high occupational complexity could not compensate for the effect of low childhood grades. In contrast, dementia risk was reduced in those with higher school grades, irrespective of occupational complexity. Conclusion: Higher childhood school performance is protective of dementia risk, particularly when preserved through complex work environments in adulthood, although it will remain protective even in the absence of later-life educational or occupational stimulation.

  • 215. Dekker, Joost
    et al.
    Bai, Bo
    Oldenburg, Brian
    Qiu, Chengxuan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Zhong, Xuefeng
    Behavioral medicine in China2014Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, nr 4, s. 571-573Artikel i tidskrift (Övrigt vetenskapligt)
  • 216. Descatha, Alexis
    et al.
    Magnusson Hanson, Linda L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Madsen, Ida E. H.
    Rugulies, Reiner
    Peristera, Paraskevi
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Accuracy of a Single Item on Mentally Tiring Work as Proxy Measure of Job Demands and Efforts in the Gazel Cohort2017Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, nr 8, s. E156-E158Artikel i tidskrift (Refereegranskat)
  • 217. Descatha, Alexis
    et al.
    Sembajwe, Grace
    Baer, Michael
    Boccuni, Fabio
    Di Tecco, Cristina
    Duret, Clement
    Evanoff, Bradley A.
    Gagliardi, Diana
    Ivanov, Ivan D.
    Leppink, Nancy
    Marinaccio, Alessandro
    Magnusson Hanson, Linda L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Ozguler, Anna
    Pega, Frank
    Pell, John
    Pico, Fernando
    Pruss-Ustun, Annette
    Ronchetti, Matteo
    Roquelaure, Yves
    Sabbath, Erika
    Stevens, Gretchen A.
    Tsutsumi, Akizumi
    Ujita, Yuka
    Iavicoli, Sergio
    WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on stroke2018Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 119, s. 366-378Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from stroke attributable to exposure to long working hours, to inform the development of the WHO/ILO joint methodology. Objectives: We aim to systematically review studies on occupational exposure to long working hours (called Systematic Review 1 in the protocol) and systematically review and meta-analyse estimates of the effect of long working hours on stroke (called Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way. Data sources: Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CISDOC and PsychINFO. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference list of previous systematic reviews and included study records; and consult additional experts. Study eligibility and criteria: We will include working-age (>= 15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (< 15 years) and unpaid domestic workers. For Systematic Review 1, we will include quantitative prevalence studies of relevant levels of occupational exposure to long working hours (i.e. 35-40, 41-48, 49-54 and >= 55 h/week) stratified by country, sex, age and industrial sector or occupation, in the years 2005-2018. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the relative effect of a relevant level of long working hours on the incidence of or mortality due to stroke, compared with the theoretical minimum risk exposure level (i.e. 35-40 h/week). Study appraisal and synthesis methods: At least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2.

  • 218. Di Gessa, Giorgio
    et al.
    Corna, Laurie M.
    Platts, Loretta G.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Worts, Diana
    McDonough, Peggy
    Sacker, Amanda
    Price, Debora
    Glaser, Karen
    Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach2017Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, nr 5, s. 431-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early. Methods Our data come from waves 2-4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65-74 and women aged 60-69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood. Results Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant. Conclusions Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

  • 219. Di Milia, Lee
    et al.
    Kecklund, Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    The distribution of sleepiness, sleep and work hours during a long distance morning trip: A comparison between night- and non-night workers2013Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 53, s. 17-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Few studies have examined the extent of driver sleepiness during a long distance morning trip. Sleepiness at this time may be high because of night work, waking early to commence work or travel, sleep disorders and the monotony of driving long distances. The objective of this study was to estimate the prevalence of chronic sleepiness (Epworth sleepiness score ≥10) and sleep restriction (≤5h) in a sample of 649 drivers. Participants driving between 08:00 and 10:00 on three highways in regional Australia participated in a telephone interview. Approximately 18% of drivers reported chronic sleepiness. The proportions of night workers (NW) and non-night workers (NNW) with chronic sleepiness were not significantly different but males reported a significantly greater proportion of chronic sleepiness than females. The NW group had a significantly greater proportion of drivers with ≤5h of sleep in the previous 24 and 48h, fewer nights of full sleep (≤4), acute sleepiness and longer weekly work hours. The NW group reported driving a significantly longer distance at Time 1 (Mean=140.29±72.17km, versus 117.55±89.74km) and an additional longer distance to complete the journey (Mean=89.33±95.23km, versus 64.77±94.07km). The high proportions of sleep restriction and acute sleepiness among the NW group, and the amount of chronic sleepiness in the NW and NNW groups reported during a long distance morning trip may be of concern for driver safety.

  • 220. Dietze, Paul
    et al.
    Ferris, Jason
    Room, Robin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD). Turning Point Alcohol and Drug Centre, Australia; University of Melbourne, Australia.
    Who Suggests Drinking Less?: Demographic and National Differences in Informal Social Controls on Drinking2013Ingår i: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 74, nr 6, s. 859-866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The purpose of this study was to examine variation in reports of pressuring others to drink less, as a form of informal social control of drinking, across countries and different types of relationship to the respondent. Method: A cross-sectional survey was administered to 19,945 respondents ages 18-69 years in 14 countries included in the data set of the Gender, Alcohol and Culture: An International Study (GENACIS). Outcome variables were respondents' reports of pressuring others to drink less (yes/no) across a variety of relationships (their partners, other family members, workmates, or friends). Multilevel, multivariable logistic regression analysis was carried out on each outcome variable. The fixed-effects components included the Level 1 (individual) covariates of respondent age, gender, drinking status, and education level as well as the Level 2 (country level) covariates of percentage female drinkers and purchasing power parity. The random-effects components included country and current drinking status. Results: Respondents most frequently reported pressuring male friends to drink less (18%), followed by male family members (other than partners, 15%), partners (15%), work colleagues (12%), female friends (9%), female family members (other than partners, 6%), and children (5%). There was marked variation across countries, with pressuring frequently reported in Uganda, Costa Rica, and Nicaragua across most relationship types. Multivariable logistic regression revealed consistent effects of gender, with women more likely than men to report pressuring others to drink less across most relationship types. The patterns in relation to education status and age were less consistent and varied across relationship type. Conclusions: Informal social control of drinking varies dramatically according to whom is most likely to pressure whom to drink less as well as the country in which people live.

  • 221. Doheny, Megan
    et al.
    Agerholm, Janne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Orsini, Nicola
    Schön, Pär
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Burström, Bo
    Socio-demographic differences in the frequent use of emergency department care by older persons: a population-based study in Stockholm County2019Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, artikel-id 202Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In Sweden, the number of older people using emergency department (ED) care is rising. Among older persons an ED visit is a stressful event, which potentially could have been prevented or treated at other levels of care. Frequent ED use (> 4 visits a year) by older persons might reflect issues in the organisation of health care system to address their needs. We aimed to explore socio-demographic differences among older people seeking ED care in terms age and gender, and to investigate the association between income and frequent ED use. Methods: A population-based study analysing the utilisation of ED care by (N = 356,375) individuals aged 65+ years. We linked register data on socio-demographic characteristics from 2013 to health care utilisation data in 2014. Multivariable logistic regression was used to estimate the income differences in the frequent use of ED care, adjusting for living situation, country of birth, residential area, age in years, multi-morbidity and the use of other health care services. Results: Those 65+ years accounted for (27%) of all ED visits in Stockholm County in 2014. In the study population (2.5%) were identified as frequent ED users, who were predominantly in the lower income groups, living alone or in an institution, had more multi-morbidity, and utilised more of other health care services. The lowest income groups had a three-fold greater odds of being a frequent ED user than those in the highest income group. In the adjusted models, the odds were reduced by 12-44% for those in the lowest income groups. However, age and gender differences were observed with men 65-79 years (OR 1.75 CI: 1.51-2.03) and women 80+ years (OR 150, CI 1.19-1.87) in the lowest income groups having a higher odds of frequent ED use. Conclusion: This study observed that ED visits by older persons are driven by a need of care, and those that frequently visit hospital-based EDs are a socially disadvantaged group, which suggests that the organisation of care for older people should be reviewed in order to better meet their needs in other levels of care.

  • 222. Dorlo, Thomas P. C.
    et al.
    Fernández, Carmen
    Stockholms universitet, Naturvetenskapliga fakulteten, Institutionen för molekylär biovetenskap, Wenner-Grens institut.
    Troye-Blomberg, Marita
    Stockholms universitet, Naturvetenskapliga fakulteten, Institutionen för molekylär biovetenskap, Wenner-Grens institut.
    De Vries, Peter J.
    Boraschi, Diana
    Mbacham, Wilfred F.
    Poverty-Related Diseases College: a virtual African-European network to build research capacity2016Ingår i: BMJ global health, ISSN 2059-7908, Vol. 1, nr 1, artikel-id e000032Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Poverty-Related Diseases College was a virtual African-European college and network that connected young African and European biomedical scientists working on poverty-related diseases. The aim of the Poverty-Related Diseases College was to build sustainable scientific capacity and international networks in poverty-related biomedical research in the context of the development of Africa. The Poverty-Related Diseases College consisted of three elective and mandatory training modules followed by a reality check in Africa and a science exchange in either Europe or the USA. In this analysis paper, we present our experience and evaluation, discuss the strengths and encountered weaknesses of the programme, and provide recommendations to policymakers and funders.

  • 223.
    Drefahl, Sven
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Ahlbom, Anders
    Modig, Karin
    Losing Ground - Swedish Life Expectancy in a Comparative Perspective2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 2, s. e88357-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the world's longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. Methods: We look at life expectancy over the years 1970-2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. Results: Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. Conclusions: Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground.

  • 224.
    Drefahl, Sven
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lundström, Hans
    Modig, Karin
    Ahlbom, Anders
    The era of centenarians: mortality of the oldest old in Sweden2012Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 272, nr 1, s. 100-102Artikel i tidskrift (Refereegranskat)
  • 225. Dribe, Martin
    et al.
    Juárez, Sol Pía
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). Lund University, Sweden.
    Scalone, Francesco
    Is It Who You Are or Where You Live? Community Effects on Net Fertility at the Onset of Fertility Decline: A Multilevel Analysis Using Swedish Micro-Census Data2017Ingår i: Population, Space and Place, ISSN 1544-8444, E-ISSN 1544-8452, Vol. 23, nr 2, artikel-id e1987Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper studies contextual effects on fertility at the onset of fertility decline in Sweden. We argue that the community exerts an influence on fertility when individuals belonging to a certain community are more similar to one another (within-area) in their reproductive behaviour than individuals living in another community (between-area). Our hypotheses are that community had a strong influence in the past but that it decreased over time as more individualistic values grew in importance. We expect that the community exerted a greater impact in the low socioeconomic groups as the elite were less constrained by proximity and, therefore, more exposed to new ideas crossing community borders. Using micro-census data from 1880, 1890, and 1900, we use multilevel analysis to estimate measures of intra-class correlation within areas. We measure net fertility by the number of own children under five living in the household to currently married women with their spouses present. Parish is used as proxy for community. Our results indicate that despite average differences in fertility across parishes, the correlation between individuals belonging to the same community is less than 2.5%, that is, only a negligible share of the number of children observed is attributable to true community effects. Contrary to our expectation, we do not find any substantial change over time. However, as expected, community has a greater impact in the low socioeconomic groups. Our findings suggest that it is who you are rather than where you live which explains fertility behaviour during the initial stages of the transition.

  • 226.
    Dunlavy, Andrea C.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Garcy, Anthony M.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Educational mismatch and health status among foreign-born workers in Sweden2016Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 154, s. 36-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Foreign-born workers have been shown to experience poorer working conditions than native-born workers. Yet relationships between health and educational mismatch have been largely overlooked among foreign-born workers. This study uses objective and self-reported measures of educational mismatch to compare the prevalence of educational mismatch among native (n = 2359) and foreign born (n = 1789) workers in Sweden and to examine associations between educational mismatch and poor self-rated health. Findings from weighted multivariate logistic regression which controlled for social position and individual-level demographic characteristics suggested that over-educated foreign-born workers had greater odds ratios for poor-self rated health compared to native-born matched workers. This association was particularly evident among men (OR = 2.14, 95% CI: 1.04-4.39) and women (OR = 2.13, 95% CI: 1.12-4.03) from countries outside of Western Europe, North America, and Australia/New Zealand. Associations between under-education and poor-self rated health were also found among women from countries outside of Western Europe, North America, and Australia/New Zealand (OR = 2.02, 95% CI: 1.27-3.18). These findings suggest that educational mismatch may be an important work-related social determinant of health among foreign-born workers. Future studies are needed to examine the effects of long-term versus short-term states of educational mismatch on health and to study relationships over time.

  • 227.
    Dunlavy, Andrea C.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden2018Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, nr 5, s. 891-897Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality.

    Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models.

    Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups.

    Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

  • 228.
    Dunlavy, Andrea C.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Toivanen, Susanna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Mälardalen University, Sweden.
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status2019Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, nr 5, s. 579-590Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.

    METHODS: Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    RESULTS: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.

    CONCLUSIONS: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

  • 229.
    Dunlavy, Andrea C.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Health Inequalities among Workers with a Foreign Background in Sweden: Do Working Conditions Matter?2013Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 10, nr 7, s. 2871-2887Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18–65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

  • 230.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Juárez, Sol
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Toivanen, Susanna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Migration background characteristics and the association between unemployment and suicide2017Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, nr Suppl. 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Persons of foreign-origin have higher rates of unemployment compared to those of native-origin, yet few studies have assessed relationships between unemployment and mental health in persons of foreign-origin relative to the native-origin. This study aims to examine the extent to which generational status, region of origin, age at arrival, and duration of residence modify the relationship between employment status and suicide risk.

    Methods

    Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993-2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.

    Results

    Elevated hazard ratios for suicide were observed among the majority of foreign-origin persons exposed to unemployment. Second generation Swedish men exposed to unemployment demonstrated significantly greater (p < 0.05) excess risk of suicide (HR = 3.63, 95% CI: 2.90-4.54) than that observed among native-origin Swedish men exposed to unemployment (HR = 1.67, 95% CI: 1.29-2.16). In unemployed foreign-born men, younger age at arrival and longer duration of residence were associated with increased risk of suicide, whereas unemployed foreign-born men who arrived as adults and had a shorter duration of residence did not demonstrate excess suicide risk.

    Conclusions

    Analyses indicated that the majority of the foreign-origin exposed to unemployment demonstrated excess risk of suicide that was of a similar magnitude to that observed among their native-origin counterparts. Yet there were notable differences in patterns of association by generational status, region of origin, age at arrival, and duration of residence. The high excess risk observed in unemployed second generation men suggests that ensuring employment among this group may be of particular public health importance.

  • 231.
    Dunlavy, Andrea
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Arbetsmiljön bland utrikesfödda anställda i Sverige2017Ingår i: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 23, nr 1, s. 46-65Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Denna artikel syftar till att utöka kunskapen kring arbetsmiljöförhållanden bland utlandsfödda på den svenska arbetsmarknaden. Studien undersöker hur exponering för bristfälliga psykosociala, strukturella och fysiska arbetsmiljöförhållanden varierar mellan olika grupper av anställda kvinnor och män beroende på födelseland. Resultaten visar skillnader när det gäller exponering för bristfälliga arbetsmiljöförhållanden mellan utlandsfödda och inrikes födda anställda på den svenska arbetsmarknaden. Dessa skillnader beror på den grupp som undersöks och det arbetsmiljöproblem som studeras.

  • 232.
    Edman, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Depoliticising the political: Market solutions and the retreat of Swedish institutional drug treatment from state management2016Ingår i: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 32, s. 93-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. Methods: The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. Results: The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. Conclusion: The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means.

  • 233.
    Edman, Johan
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Berndt, Josefine
    Stockholms universitet, Humanistiska fakulteten, Historiska institutionen.
    Oniomaniacs: the popular framing of consumption as a disease2018Ingår i: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 26, nr 6, s. 431-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this article is to examine the framing of excessive consumption as a disease-like condition in the Swedish press during the years 1992-2012. Against a theoretical background discussing medicalisation, we have analysed the characteristics of problematic consumption framed as a disease, as well as the presumed causes of and responses to this problem. Alongside and intertwined with a structural and a rationalisation perspective, we find discussions and explanations of problematic consumption as a disease all through the investigated period. Class and gender are noticeable components of the core problem description, but the reductionist assumption of addiction as a brain disease seems to point to a problem beyond historical and social context. The disease conceptualisation of problematic consumption can be seen as a compensatory perspective in an individualising and consumption affirming society. However, this perspective is ultimately decided by politics and not by research. Despite being a frequently occurring perspective on a conceptual level in Sweden, it is not a legitimate description in legislation or as a cause for public treatment interventions.

  • 234. Einiö, Elina
    et al.
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Risk of Hospitalization for Cancer, Musculoskeletal Disorders, Injuries, or Poisonings Surrounding Widowhood2019Ingår i: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, nr 1, s. 110-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Psychological distress has been indicated to affect the risk of death from cardiovascular disease, cancer, and external causes. Mortality from these major causes of death is also known to be elevated after widowhood when distress is at a heightened level. Surprisingly little is known about changes in health other than mental and cardiac health shortly before widowhood. We used longitudinal data on widowed (n = 19,185) and continuously married (n = 105,939) individuals in Finland (1996-2002) to assess the risk of hospitalization for cancer and for external and musculoskeletal causes surrounding widowhood or random dates. We fitted population-averaged logit models using longitudinal data of older adults aged 65 years or over. The results show that hospitalization for injuries had already increased prior to widowhood and clearly peaked after it. The increases were largely related to falls. A similar increasing pattern of findings was not found around a random date for a group of continuously married individuals. Hospitalizations for cancer and musculoskeletal disorders appeared to be unrelated to the process of widowhood. Hospitalizations for poisonings increased after widowhood. The results imply that the process of widowhood is multifaceted and that various types of health changes should be studied separately and before the actual loss.

  • 235. Einiö, Elina
    et al.
    Moustgaard, Heta
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Leinonen, Taina
    Does the risk of hospitalisation for ischaemic heart disease rise already before widowhood?2017Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, nr 6, s. 599-605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The death of a spouse has been shown to increase mortality from various causes, including ischaemic heart disease. It is unclear, however, whether cardiac problems are already on the rise before widowhood.

    Methods Using longitudinal register data of Finnish widows-to-be aged 65 and over at baseline (N=19 185), we assessed the risk of hospitalisation for ischaemic heart disease 18 months before and after widowhood. Hospital admissions were derived from national hospital discharge registers between 1996 and 2002. Analyses used population-averaged and fixed-effects logistic models, the latter of which controlled for unobserved time-invariant characteristics, such as genetic susceptibility, personality and behavioural and medical history.

    Results For men, fixed-effects model revealed that hospitalisation for ischaemic heart disease increased twofold already 0–3 months prior to the death of a spouse (OR=2.09, 95% CI 1.22 to 3.60), relative to the period of 15–18 months before widowhood. It stayed at a heightened level up to 6 months following bereavement (OR=2.15, 95% CI 1.07 to 4.30). Among women, the fixed-effects analysis detected no statistically significant increase in hospitalisation for ischaemic heart disease before or after widowhood.

    Conclusions These findings indicate that men are already vulnerable to cardiac problems before the death of a wife. Medical interventions and health counselling could be targeted to the husbands of terminally ill patients, in order to improve their cardiovascular health over the transition to widowhood.

  • 236. Einiö, Elina
    et al.
    Nisén, Jessica
    Martikainen, Pekka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS). University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany.
    Number of children and later-life mortality among Finns born 1938-502016Ingår i: Population Studies, ISSN 0032-4728, E-ISSN 1477-4747, Vol. 70, nr 2, s. 217-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We investigated the association between number of offspring and later-life mortality of Finnish men and women born 1938–50, and whether the association was explained by living conditions in own childhood and adulthood, chronic conditions, fertility timing, and unobserved characteristics common to siblings. We used a longitudinal 1950 census sample to estimate mortality at ages 50–72. Relative to parents of two children, all-cause mortality is highest among childless men and women, and elevated among those with one child, independently of observed confounders. Fixed-effect models, which control for unobserved characteristics shared by siblings, clearly support these findings among men. Cardiovascular mortality is higher among men with no, one, or at least four children than among those with two. Living conditions in adulthood contribute to the association between the number of children and mortality to a greater extent than childhood background, and chronic conditions contribute to the excess mortality of the childless.

  • 237. Ek, Weronica E.
    et al.
    Reznichenko, Anna
    Ripke, Stephan
    Niesler, Beate
    Zucchelli, Marco
    Rivera, Natalia V.
    Schmidt, Peter T.
    Pedersen, Nancy L.
    Magnusson, Patrik
    Talley, Nicholas J.
    Holliday, Elizabeth G.
    Houghton, Lesley
    Gazouli, Maria
    Karamanolis, George
    Rappold, Gudrun
    Burwinkel, Barbara
    Surowy, Harald
    Rafter, Joseph
    Assadi, Ghazaleh
    Li, Ling
    Papadaki, Evangelia
    Gambaccini, Dario
    Marchi, Santino
    Colucci, Rocchina
    Blandizzi, Corrado
    Barbaro, Raffaella
    Karling, Pontus
    Walter, Susanna
    Ohlsson, Bodil
    Törnblom, Hans
    Bresso, Francesca
    Andreasson, Anna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Dlugosz, Aldona
    Simrén, Magnus
    Agréus, Lars
    Lindberg, Greger
    Boeckxstaens, Guy
    Bellini, Massimo
    Stanghellini, Vincenzo
    Barbara, Giovanni
    Daly, Mark J.
    Camilleri, Michael
    Wouters, Mira M.
    D'Amato, Mauro
    Exploring the genetics of irritable bowel syndrome: a GWA study in the general population and replication in multinational case-control cohorts2015Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, nr 11, s. 1774-1782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: IBS shows genetic predisposition, but adequately powered gene-hunting efforts have been scarce so far. We sought to identify true IBS genetic risk factors by means of genome-wide association (GWA) and independent replication studies.

    DESIGN: We conducted a GWA study (GWAS) of IBS in a general population sample of 11 326 Swedish twins. IBS cases (N=534) and asymptomatic controls (N=4932) were identified based on questionnaire data. Suggestive association signals were followed-up in 3511 individuals from six case-control cohorts. We sought genotype-gene expression correlations through single nucleotide polymorphism (SNP)-expression quantitative trait loci interactions testing, and performed in silico prediction of gene function. We compared candidate gene expression by real-time qPCR in rectal mucosal biopsies of patients with IBS and controls.

    RESULTS: One locus at 7p22.1, which includes the genes KDELR2 (KDEL endoplasmic reticulum protein retention receptor 2) and GRID2IP (glutamate receptor, ionotropic, delta 2 (Grid2) interacting protein), showed consistent IBS risk effects in the index GWAS and all replication cohorts and reached p=9.31×10(-6) in a meta-analysis of all datasets. Several SNPs in this region are associated with cis effects on KDELR2 expression, and a trend for increased mucosal KDLER2 mRNA expression was observed in IBS cases compared with controls.

    CONCLUSIONS: Our results demonstrate that general population-based studies combined with analyses of patient cohorts provide good opportunities for gene discovery in IBS. The 7p22.1 and other risk signals detected in this study constitute a good starting platform for hypothesis testing in future functional investigations.

  • 238. Ekelund, Ulf
    et al.
    Tarp, Jakob
    Steene-Johannessen, Jostein
    Hansen, Bjørge H.
    Jefferis, Barbara
    Fagerland, Morten W.
    Whincup, Peter
    Diaz, Keith M.
    Hooker, Steven P.
    Chernofsky, Ariel
    Larson, Martin G.
    Spartano, Nicole
    Vasan, Ramachandran S.
    Dohrn, Ing-Mari
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Hagströmer, Maria
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Karolinska University Hospital, Sweden.
    Edwardson, Charlotte
    Yates, Thomas
    Shiroma, Eric
    Anderssen, Sigmund A.
    Lee, I-Min
    Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis2019Ingår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 366, artikel-id l4570Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVE

    To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.

    DESIGN

    Systematic review and harmonised meta-analysis.

    DATA SOURCES

    PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.

    ELIGIBILITY CRITERIA

    Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.

    DATA EXTRACTION AND ANALYSIS

    Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.

    MAIN OUTCOME MEASURE

    All cause mortality.

    RESULTS

    39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).

    CONCLUSION

    Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.

  • 239.
    Elling, Devy
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap. Karolinska Institutet, Sweden.
    Surkan, Pamela J.
    Enayati, Sahba
    El-Khatib, Ziad
    Sex differences and risk factors for diabetes mellitus - an international study from 193 countries2018Ingår i: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 14, artikel-id 118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Increases in overweight and obesity among youths have resulted in the diagnosis of Type 2 diabetes mellitus (T2DM) at earlier ages. The impact of lifestyle-related factors has been implicated; however, its relation to morbidity and mortality and sex differences remain unclear. We aimed to document the changes in risk factors and sex differences associated with T2DM-related morbidity and mortality during 1995-2015.

    Method: We used mortality rates and morbidity estimates from the Global Burden of Diseases Study 2016 using Disability-Adjusted Life Years (DALY). Multiple linear regression analyses were used to determine associations between T2DM-related mortality and related risk factors. DALYs were grouped by country income level, and were stratified by sex.

    Results: Increases in mortality were observed for both sexes, and females tended to have higher mortality rates per 100,000 persons. Body mass index (BMI) continued to be the leading risk factor for T2DM-related mortality, and increases in BMI were more common in low- and middle-income countries (LIC and MIC). Low physical activity was strongly associated with mortality rates, followed by dietary risks and smoking (2.4; 1.4; 0.8 per 100,000 persons, respectively). Similar patterns were observed after adjustments for income level, sex, and age. DALYs continued to show increasing trends across all income levels during 1995-2015 (high-income (HIC):16%; MIC: 36%; LIC: 12%). Stratification by sex showed similar results; males had fewer T2DM DALYs than females, though a greater increase was observed among males.

    Conclusion: Overall, T2DM related mortality was higher among females. Compared to in HIC, there appeared to be a considerable increase in the burden of T2DM in MIC and LIC, where BMI is the leading risk factor for T2DM-related mortality. Prevention programs should emphasize related risk factors according to the existing standard of care.

  • 240. Elstad, Jon Ivar
    et al.
    Hermansen, Åsmund
    Brønnum-Hansen, Henrik
    Martikainen, Pekka
    Östergren, Olof
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Tarkiainen, Lasse
    Income security in Nordic welfare states for men and women who died when aged 55–69 years old2019Ingår i: Journal of International and Comparative Social Policy, ISSN 2169-9763, E-ISSN 2169-978X, Vol. 35, nr 2, s. 157-176Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Income security when health impairment or other social risks occur is a major objective of welfare states. This comparative study uses register data from four Nordic welfare states for examining equivalized disposable income during the last 12 years alive among men and women who died when aged 55–69 years old. The analysed outcome indicates the aggregate result of a varied set of income maintenance mechanisms. Median income increased in the Finnish, Norwegian and Swedish samples, but decreased somewhat in Denmark, probably due to relatively frequent transitions to retirement and larger income drops after retirement than in the other Nordic countries. Analyses of comparison samples weighted by propensity scores indicated a better income development among those who lived beyond the observation period than among those who died. The higher educated had a more favourable income development during the years prior to death than those with low education.

  • 241.
    Elveborg Lindskog, Elina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    The effect of war on infant mortality in the Democratic Republic of Congo2016Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, artikel-id 1059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Democratic Republic of Congo (DRC) has suffered from war and lingering conflicts in East DRC and has one of the highest infant mortality rates in the world. Prior research has documented increases in infant and child mortality associated with war, but the empirical evidence is limited in several respects. Measures of conflict are quite crude or conflict is not tightly linked to periods of exposure to infant death. Few studies have distinguished between the effects of war on neonatal versus post-neonatal infants. No study has considered possible differences between women who give birth during wartime and those who do not that may be related to greater infant mortality. Methods: The analysis used the nationally representative sample of 15,103 mothers and 53,768 children from the 2007 and 2013/2014 Demographic Health Survey in the DRC and indicators of conflict events and conflict deaths from the 2013 Uppsala Conflict Data. To account for unobserved heterogeneity across women, a multi-level modeling approach was followed by grouping all births for each woman and estimating random intercepts in discrete time event history models. Results: Post-neonatal mortality increased during the Congolese wars, and was highest where conflict events and deaths were extreme. Neonatal mortality was not associated with conflict levels. Infant mortality was not higher in East DRC, where conflicts continued during the post Congolese war period. Models specifying unobserved differences between mothers who give birth during war and those who have children in peacetime did not reduce the estimated effect of war, i.e., no support was found for selectivity in the sample of births during war. Conclusion: Differences in effects of the Congolese war on neonatal versus post-neonatal mortality suggest that conflict influences the conditions of infants' lives more than the aspects of mothers' pregnancy conditions and delivery that are relevant for infant mortality. These differences may, however, be specific to the nature of conflict and prior conditions in the DRC. Because of continued political instability, violent conflict may be expected to continue in contexts such as the DRC; we must therefore continue to document, analyze and monitor the mechanisms through which war influences infant mortality.

  • 242. Engström, K
    et al.
    Johnson, C
    Rostila, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Can social capital explain mental health inequalities between immigrant groups?2014Konferensbidrag (Övrigt vetenskapligt)
  • 243.
    Ericsson, Malin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Contraceptive behaviour and births among Swedish child welfare clients: A register based study on 14–19 year old females2012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Teen pregnancy is associated with an array of negative social and health related outcomes for the mother as well as the baby. The risk of becoming a parent before the age of 20 is clearly elevated for former child welfare clients. Aim: The aim of this study is therefore to investigate the elevated birth rates among female adolescent child welfare clients by examining the relationship between contraceptive behaviour and pregnancies. Method: The study was based on a set of compiled register data. The study population were all females between the ages 14 and 19 during the years 2006-2008 (n. 487 115). The study group of main interest were child welfare clients who were compared to peers in the majority population as well as international and national adoptees. Analysis was conducted with multivariate logistic regression and the observed association was controlled for maternal, socio-demographic and behavioural factors. Results: The two sub-populations of child welfare clients both had much higher rates of retrieved hormonal contraceptives compared to the majority population, the international and the national adoptees up to age 17. In the ages 18 and 19 the rates were instead lower than the majority population. The child welfare clients had a stronger association to births than all groups of comparison, which was consistent with earlier research. All findings persisted after controlling for socio-demographic, maternal and behavioural factors. Conclusion: The child welfare clients showed a specific pattern of contraceptive behaviour over the age groups which was not consistent with the groups of comparison or with the expected relationship to birth rates. This suggests that teenage births cannot unanimously be predicted by the rates of retrieved hormonal contraceptives. The results imply that other factors than those investigated in this study are more influential regarding the contraceptive behaviour of this adolescent population.

  • 244.
    Eriksson, Charli
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Kimber, Birgitta
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol2018Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, artikel-id 1250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012-2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children's resilience.

    Methods/design: RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017-2019. The study is being performed by Junis, IOGT-NTO's Junior Association, part of IOGT International, in conjunction with researchers at Goteborg, Umea and Stockholm universities, and is being funded by the Public Health Agency of Sweden.Around 1000 children of the ages 7-12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children's protective factors.Based on the work with groups of children, an effectiveness study including children aged 7-12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

    Discussion:The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

  • 245.
    Eriksson, Lena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Institutionen för folkhälsovetenskap.
    Edman, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Kriminologiska institutionen.
    Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century2018Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 35, nr 4, s. 257-274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.

  • 246.
    Eriksson, Lena
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Edman, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Knowledge, Values, and Needle Exchange Programs in Sweden2017Ingår i: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 44, nr 2, s. 105-124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such as needle exchange programs (NEPs), while another strand of research testifies that policy makers often neglect to take the research evidence into account and hence fail to introduce these programs. This article studies the interplay between research-based knowledge, values, and policy making during 16 years of intense parliamentary debate in Sweden on the needle exchange issue. In 2000, the future of the two existing experimental NEPs was uncertain; in 2006, the regulations were reformed; and in 2015, they underwent a government inquiry. Both the reform and the inquiry aimed at regulating and expanding the programs. The analysis is guided by work done within the tradition of science-policy nexus, where the increased emphasis on evidence-based political measures is problematized. As drug policy arouses normative and ethical concerns, the analysis also explores values. The study illustrates the central role that values play in a policy field which is repeatedly declared to be science based. Within the overall framework of the Swedish drug policy ideology of a drug-free society, the advocates of NEPs framed drug misuse as a consequence of either an unjust society or a disease, arguing that because misuse is a condition beyond the control of the individual, the Swedish welfare state has an obligation to take care of those affected. For their part, the opponents framed drug misuse as a result of misguided attitudes, which would only be corrected by restrictions and prohibition. In their view, NEPs are a tool for drug policy liberalization. In the debate between the two positions, research evidence played only a minor role.

  • 247.
    Eyjolfsdottir, Harpa Sif
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om ojämlikhet i hälsa (CHESS).
    Social capital, self-rated health and the importance of sleep: The case of Iceland in 2007 and 20092012Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    The frequently studied concept of social capital has often been related to health, but theconceptualisationand measurement of the conceptisanon-goingdebate. The main aim of this thesis is to study the relationship of four different indicators of social capital; informal social capital, formal social capital, trust towards institutions and trust towards others, with self-rated physical health and self-rated mental health in Iceland in 2009, shortly after a harsh economic crash. Insomnia symptoms will be studied as a possible mediator or moderator in the relationship. Furthermore, longitudinal data on informal social capital will be used to see the causal effect of social capital on health and to see if informal social capital decreased after the economic collapse. Population-based panel data from Iceland in 2007 and 2009 will be used to perform both cross-sectional analysis (n = 3,243) and longitudinal analysis (n = 3,131). The main results are that the four indicators of social capital all relate differently to physical and mental self-rated health, and insomnia symptoms seem to mediate the relationship between social capital and health, especially physical health. Surprisingly, informal social capital did increase during the economic collapse. The panel analysis further suggests that having poor informal social capital has causal effects on poor self-rated mental health when adjusted for symptoms of insomnia, age, gender, family status, education and smoking. 

  • 248.
    Eyjolfsdóttir, Harpa S.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Baumann, Isabel
    Agahi, Neda
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lennartsson, Carin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    How to Measure Retirement Age? A Comparison of Survey and Register Data2019Ingår i: Journal of Population Ageing, ISSN 1874-7884, E-ISSN 1874-7876Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Due to an increasing heterogeneity in retirement transitions, the measurement of retirement age constitutes a major challenge for researchers and policymakers. In order to better understand the concept of retirement age, we compare a series of measures for retirement age assessed on the basis of survey and register data. We use data from Sweden, where flexible retirement schemes are implemented and register data are available. We link survey data from the Swedish Level of Living Survey with register data from the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. We create four measures of retirement age based on these datasets, applying approaches that have been used in previous literature. We analyse the means and distributions of these measures and evaluate the correlations between them. Finally, we regress common predictors of retirement age such as gender or education on the four measures of retirement age to examine potential differences in size, direction and statistical significance of the associations. We find that the survey measure of retirement age resembles the following two ways of defining retirement age in the register data: first, the age at which people receive more than half their income from old-age or disability pension and, second, the age at which they were not gainfully employed for at least 2 years. This insight gives us a better understanding of when in the retirement transition process, individuals identify with retirement. Moreover, it provides decision support for researchers working with register data to determine which measure to use.

  • 249.
    Eyjólfsdóttir, Harpa S.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Baumann, I.
    Agahi, Neda
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fritzell, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lennartsson, Carin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Prolongation of working life and its effect on mortality and health in older adults: Propensity score matching2019Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 226, s. 77-86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many countries are raising the age of pension eligibility because of increases in life expectancy. Given the social gradient in life expectancy and health, it is important to understand the potential late-life health effects of prolonging working life and whether any effects differ by socioeconomic position. We examined the effect of prolonging working life beyond age 65 on mortality and a series of indicators of late-life physical health (the ability to climb stairs without difficulty, self-rated health, ADL limitations, and musculoskeletal pain) in a representative sample of the Swedish population. In addition to average effects, we also examined heterogeneous effects, for instance by occupational social class. To do this, we use propensity score matching, a method suitable for addressing causality in observational data. The data came from two linked Swedish longitudinal surveys based on nationally representative samples with repeated follow-ups; The Swedish Level of Living Survey and the Swedish Panel Study of Living conditions of the Oldest Old, and from national income and mortality registries. The analytical sample for the mortality outcome included 1852 people, and for late-life physical health outcomes 1461 people. We found no significant average treatment effect on the treated (ATT) of working to age 66 or above on the outcomes, measured an average of 12 years after retirement: mortality (ATT-0.039), the ability to climb stairs (ATT -0.023), self-rated health (ATT -0.009), ADL limitations (ATT -0.023), or musculoskeletal pain (ATT -0.009) in late life. Analyses of whether the results varied by occupational social class or the propensity to prolong working life were inconclusive but suggest a positive effect of prolonging working life on health outcomes. Accordingly, more detailed knowledge about the precise mechanisms underlying these results are needed. In conclusion, working to age 66 or above did not have effect on mortality or late-life physical health.

  • 250. Falkstedt, Daniel
    et al.
    Sorjonen, Kimmo
    Hemmingsson, Tomas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD). Karolinska institutet, Sverige.
    Deary, Ian J.
    Melin, Bo
    Psychosocial Functioning and Intelligence Both Partly Explain Socioeconomic Inequalities in Premature Death. A Population-Based Male Cohort Study2013Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 12, artikel-id e82031Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The possible contributions of psychosocial functioning and intelligence differences to socioeconomic status (SES)-related inequalities in premature death were investigated. None of the previous studies focusing on inequalities in mortality has included measures of both psychosocial functioning and intelligence. Methods: The study was based on a cohort of 49 321 men born 1949-1951 from the general community in Sweden. Data on psychosocial functioning and intelligence from military conscription at similar to 18 years of age were linked with register data on education, occupational class, and income at 35-39 years of age. Psychosocial functioning was rated by psychologists as a summary measure of differences in level of activity, power of initiative, independence, and emotional stability. Intelligence was measured through a multidimensional test. Causes of death between 40 and 57 years of age were followed in registers. Results: The estimated inequalities in all-cause mortality by education and occupational class were attenuated with 32% (95% confidence interval: 20-45%) and 41% (29-52%) after adjustments for individual psychological differences; both psychosocial functioning and intelligence contributed to account for the inequalities. The inequalities in cardiovascular and injury mortality were attenuated by as much as 51% (24-76%) and 52% (35-68%) after the same adjustments, and the inequalities in alcohol-related mortality were attenuated by up to 33% (8-59%). Less of the inequalities were accounted for when those were measured by level of income, with which intelligence had a weaker correlation. The small SES-related inequalities in cancer mortality were not attenuated by adjustment for intelligence. Conclusions: Differences in psychosocial functioning and intelligence might both contribute to the explanation of observed SES-related inequalities in premature death, but the magnitude of their contributions likely varies with measure of socioeconomic status and cause of death. Both psychosocial functioning and intelligence should be considered in future studies.

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