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Abstract: Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: The aim of this paper was to present the results of the first study in which nursing research literature production was studied in the relation to country and health determinants., Design: Bibliometric analysis was used., Methods: The corpus of nursing publications was harvested from the Scopus indexing and abstracting database. Using research articles' metadata (funding acknowledgments, publication years, and author affiliations), we analyzed global trends in the nursing research literature production of funded and nonfunded publications. Next, we performed a regression analysis and correlation analysis relating nursing research productivity to health and country determinants., Findings: The search resulted in 118,870 papers, among which 22.0% were funded (24.7% for G8 countries). Nursing literature production is exhibiting a positive trend. The United States is by far the most productive country in terms of funded and nonfunded literature production, although it is ranked only ninth in per capita production, for which Sweden is the most productive country regarding funded papers. The study also revealed that gross domestic product, human development factor, and gross national income were related to nursing research literature productivity., Conclusions: The positive trend in nursing research literature production (both funded and nonfunded) reveals a growth in nursing research funding. Regionally centered research literature production shows that the more developed and "rich" countries produce the majority of publications. A positive correlation is evident between country determinants and research literature production, as is a positive correlation between per capita literature research production and well-being and health determinants., Clinical Relevance: Substantial growth in terms of nursing research literature production and research funding has been identified. While a limited amount of research in this area exists, this study revealed some interesting relations between nursing literature production and country and health determinants, which might motivate nursing researchers to pursue more intensive research and funders to support further growth of nursing research funding., (© 2019 Sigma Theta Tau International.)

Background: Non-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete., Aim: To examine the associations between initial rhythm and self-reported health in CA survivors., Methods: This nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3-6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes., Results: The study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses., Conclusions: Initial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Intensive care unit (ICU) stay for a serious illness has a long-term impact on patients' physical and psychological well-being, affecting their ability to return to their everyday life. We aimed to investigate whether there are differences in health status between those who return to work and those who do not, and how demographic characteristics and illness severity impact patients' ability to return to work 12 months after intensive care for COVID-19., Research Methodology: This was a prospective longitudinal cohort study. The participants were patients who had been in intensive care for COVID-19 and had worked before contracting COVID-19. Data on return to previous occupational status, demographic data, comorbidities, intensive care characteristics, and health status were collected at a 12-month follow-up visit., Setting: General ICU at the Uppsala University Hospital in Sweden., Results: Seventy-three participants were included in the study. Twelve months after discharge from the ICU, 77 % (n = 56) had returned to work. The participants who were unable to return to work reported more severe health symptoms. The (odds ratio [OR] for not returning to work was high for critical illness OR, 12.05; 95 % confidence interval [CI], 2.07-70.29, p = 0.006) and length of ICU stay (OR, 1.06; 95 % CI, 1.01-1.11, p = 0.01) CONCLUSION: Two-thirds of the participants were able to return to work within 1 year after discharge from the ICU. The primary factors contributing to the failure to work were duration of the acute disease and presence of severe and persistent long-term symptoms., Implications for Clinical Practice: Patients' health status must be comprehensively assessed and their ability to return to work should be addressed in the rehabilitation process. Therefore, any complications faced by the patients must be identified and treated early to increase the possibility of their successful return to work., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Despite the magnitude of youth unemployment there is a lack of studies, which explore the relations between health experiences and labour market position in various contexts. The aim of this paper was to analyse health experiences among young people in NEET (not in education, employment or training) in relation to labour market position from leaving school until early adult life., Method: The population consists of everyone (six women, eight men) who became unemployed directly after leaving compulsory school in a town in Northern Sweden. Repeated personal interviews were performed from age 16 until age 33. The interviews were analysed using qualitative content analysis., Results: Health experiences can be viewed as a contextual process, related to the different phases of leaving school, entering the labour market, becoming unemployed and becoming employed. Perceived relief and hope were related to leaving compulsory school, while entering the labour market was related to setbacks and disappointments as well as both health-deteriorating and health-promoting experiences depending on the actual labour market position. Our overarching theme of "Living in the shadow of unemployment - an unhealthy life situation" implies that it is not only the actual situation of being unemployed that is problematic but that the other phases are also coloured by earlier experiences of unemployment ., Conclusion: A focus on young people's health experiences of transitions from school into the labour market brings a new focus on the importance of macroeconomic influence on social processes and contextualised mechanisms from a life-course perspective.

Many countries are adopting policies to create greater coordination and integration between acute and long-term care services. This policy is predicated on the assumption that these service areas have interdependent outcomes for patients. In this paper, we study the interdependencies between the long-term (home care) services and consultations with a primary care doctor, as used by people over 75 years. Starting with a model of individual's demand for doctor consultations, given supply, we formalize the hypothesis that exogenous increases to home care supply will reduce the number of consultations where these services are technical substitutes. Furthermore, greater coordination of public service planning and use of pooled budgets could lead to better outcomes because planners can account for these externalities. We test our main hypothesis using data from the British Household Panel Study for 1991-2009. To address potential concerns about endogeneity, we use a set of instrumental variables for home care motivated by institutional features of the social care system. We find that there is a statistically significant substitution effect between home care and doctor visits, which is robust across a range of specifications. This result has implications for policies that consider increased coordination between health care and social care systems.

This paper explores the relationship between the prolongation of working life and subjective health. Drawing on a unique combination of longitudinal data and the results of a postal survey in Sweden, we investigate the health consequences of extending working life beyond the normal retirement age of 65. To do this, we compare the health status of two groups of retired people: one group who left the labour market completely at the age of 65, and a second group who remained in employment after the age of 65. Using a standard linear probability model and controlling for a range of socio-economic variables as well as previous labour market experiences, perceived life expectancy, pre-retirement income and health, our estimations show that those continuing to work after 65 on average display a 6.8% higher probability of reporting better health during retirement than those leaving at the age of 65. However, we find that this positive correlation between the extension of working life and health is only transitory. After 6 years of retirement, the health advantage of working after the normal retirement age disappears. Furthermore, we did not find any evidence that working after the age of 65 is positively correlated with physical fitness, self-reported depressive symptoms or well-being.

Background: while there is a trend towards a compression of disability, secular trends in physiological frailty have not been investigated. The aim of this paper was to report physiological frailty in two cohorts of 75-year olds examined in 1987 and 2005., Methods: a repeated cross-sectional study : Two population-based birth cohorts of community-dwelling 75-year olds from Gothenburg, Sweden, born in 1911-12 (n = 591) and 1930 (n = 637) were examined with identical methods in 1987 and 2005. Measures were three frailty criteria from Fried's frailty phenotype: low physical activity, slow gait speed and self-reported exhaustion., Results: seventy-five-year olds examined in 2005 were less frail according to the criteria low physical activity compared with those examined in 1987 (3 versus 18%, P < 0.001).This was seen both in women and in men, and among those with basic and more than basic educational level. Further, men with basic education were less frail in 2005 compared with those in 1987 in slow gait speed (non-significant when adjusted for body height) and low self-rated fitness, while no cohort differences were seen in men with more than basic education. Women with more than basic education were less frail in 2005 compared with those in 1987 in slow gait speed and self-rated fitness, while no cohort difference was seen in women with basic education., Conclusion: less 75-year olds were physiologically frail in 2005 compared with those in 1987, with the exception of women with low educational level, suggesting that this is a disadvantaged group that needs to receive particular attention with regard to physiological frailty., (© The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: The understanding of the complex relationship between the home environment, well-being and daily functioning in the third age is currently weak. The aim of this paper is to present the methodological background of the Home and Health in the Third Age Study, and describe a sample of men and women in relation to their home and health situation., Methods and Design: The study sample included 371 people aged 67-70, living in ordinary housing in the south of Sweden. Structured interviews and observations were conducted to collect data about objective and perceived aspects of home and health., Results: The majority of the participants were in good health and had few functional limitations. Women had more functional limitations and reported more symptoms than men. Environmental barriers were found in every home investigated; the most were found in the kitchen and hygiene area. Environmental barriers were more common in multi-family than in one-family dwellings., Discussion: This study will increase our knowledge on home and health dynamics among people in the third age. The results have potential to contribute to societal planning related to housing provision, home care and social services for senior citizens.

Hereditary angioedema (HAE) due to C1 inhibitor deficiency is a rare disease characterized by attacks of edema, known to impact quality of life (QoL). This study investigates the burden of HAE in Swedish patients, both children and adults. We used a retrospective registry study of Swedish patients with HAE, captured by the Sweha-Reg census. Data were collected using a paper-based survey. Patients completed EuroQoL 5 Dimensions 5 Levels (EQ5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions related to patient's age and sex and other variables, such as attack location and severity, were included to better understand the burden of HAE. EQ5D-5L values were estimated for the two HAE disease states. Patient-reported sick leave was also analyzed. A total of 103 responses were analyzed from 139 surveys (74% response rate). One hundred one reported an EQ5D today score (mean, 0.825) and 78 reported an EQ5D attack score (mean, 0.512) with significant differences between the two states (p < 0.0001). This difference was observed for both mild (p < 0.05), moderate (p < 0.0001), and severe attacks (p < 0.0001). Attack frequency had a negative effect on EQ5D today. Patients with >30 attacks a year had a significantly lower EQ5D today score than those with less frequent attacks. Of 74 participants, 33 (44.6%) had been absent from work or school during the latest attack and, of those with a severe attack, 81% had been absent. HAE has a significant impact on QoL both during and between attacks and on absenteeism during attacks.

Background: Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: "How would you assess your general state of health?"(General SRH) or "How would you assess your general state of health compared to persons of your own age?"(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers., Methods: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden., Results: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was "good", while the most common answer to the Comparative SRH was "similar". The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ - mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics., Conclusions: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

Background: A randomised study in non-resectable rectal cancer showed that preoperative chemoradiotherapy (CRT) resulted in better local control and disease-specific survival, but not overall survival than radiotherapy alone. The present paper presents long-term (>4 years) health-related quality of life (HRQoL) and a comparison between the results and reference values from the Norwegian general population., Material and Methods: A total of 207 patients with primarily non-resectable rectal cancer were randomised to preoperative CRT (2Gyx25+5FU/leucovorin) or RT (2Gyx25) before surgery. HRQoL was assessed using EORTC QLQ-C30, completed at baseline and sent to all patients alive in Norway and Sweden (n=105) after a minimum of 4 years post treatment. A difference of ≥5 points on the 0-100 scales was considered clinically significant., Results: Seventy-six (72%) patients answered at follow-up. No statistically significant differences between the CRT and RT groups appeared at follow-up, although clinically significant differences in social functioning, dyspnoea and diarrhoea were found. Over time, a clinically significant reduction in physical functioning was found in both groups. Moreover, reduced social functioning and less diarrhoea in the CRT group and better role functioning and more diarrhoea in the RT group were found. Comparisons between the study group and age and gender matched reference values indicate impaired social functioning and more diarrhoea among the patients., Conclusion: There were no statistically significant differences in HRQoL between the randomisation groups. In general, despite having impaired social functioning and more diarrhoea, patients reported HRQoL comparable with the reference population several years after treatment., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population., (© 2011 Taylor & Francis)

In this paper we contribute to discussion on the relationship between different aspects of socio-economic status (SES) and health. Separating different aspects of SES facilitates the specification of a structural relationship between SES indicators and morbidity. Longitudinal data and the utilization of growth curve modelling enable an empirical analysis of the direct relationship between changes over time in SES indicators and changes in morbidity. Our empirical analysis is based on panel data (N = 2976) derived from the annual Swedish Survey of Living Conditions. The panel, which consists of respondents that at the first panel wave were between 31 and 47 years old, is followed for 16 years, starting in 1979. Data are gathered at three points of time. A growth curve model is set up using structural equation modelling. The structural relationship and changes over time are simultaneously estimated. It is shown that in relation to health occupational position is crucial, canalising the effects of class of origin and education. More prestigious jobs are related to initially good health and to a less rapid deterioration in health. At the same time initial health affects occupational mobility, confirming a health selection into less prestigious jobs. It is also shown that change of occupation and income are related to change in health. The analysis confirms a strong relationship between SES and morbidity and shows that initial SES affects later changes in morbidity, i.e., a causal relationship exists between SES and morbidity. But, the analysis also demonstrates the existence of selection effects, meaning that initial morbidity causes less favourable changes in SES. It is finally revealed that changes in occupational prestige and income changes co-vary with changes in morbidity. Hence, the analysis provides basic information necessary to make any assumption about causality and selection in relation to SES and health., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to test a model proposing that the relationship between personality factors and women's quality of life (QoL) is mediated by degree of depression and the way in which every day activity and general health were appraised. Specifically, the paper addressed the mediating contribution of activity., Methods: A sample of 488 women, 38 or 50 years old, filled out questionnaires regarding the target variables. The personality traits measured were extraversion and neuroticism, and the activity aspect addressed was the value linked with everyday activities. Additionally, general health and depressive state was rated. Structural equation modeling was used to analyze the data., Results: A model was found where health, activity and depressive state mediated the association between personality and QoL. Health explained in total nearly 30% of the variation in QoL. Activity predicted 12% of the variance in QoL, partly as a unique factor and partly mediated by depressive state and health. Extraversion was linked to QoL only through activity, and neuroticism through depressive state and health., Conclusions: Our analysis supported that there was a link between personality and QoL and that perceived general health was an important contributor to QoL. Moreover, it contributed new knowledge regarding the importance of valued and satisfying activities. If this proves to be a consistent finding in future studies, including intervention research, monitoring women's daily activities might be a pathway to improved QoL.

In this paper we examine health among breast cancer 5-year survivors. We raise two questions: (1) how do the health level of this survival group compare to the health level of the general population; and (2) how have the health levels among these survivors changed over time. We found that 5-year breast cancer survivors assess their health lower than the general population, and that having being diagnosed in a later year increases health compared to having received the diagnosis at an earlier point in time. This implies that screening and treatment of breast cancer have been successful. Further, we did not find any statistically significant effect of the length of the time spell since diagnosis on health. One reason for this may be that those additional individuals surviving over time as a result of improved treatment therapies have on average lower health levels than those who survived before more efficient medical technologies were introduced.

This paper investigates the relationship between institutional trust in the health-care system, i.e. an institutional aspect of social capital, and self-rated health, and whether the strength of this association is affected by access to health-care services. The 2004 public health survey in the Scania region of Sweden is a cross-sectional study; a total of 27,963 respondents aged 18-80 years answered a postal questionnaire, which represents 59% of the random sample. Logistic regression model was used to investigate the association between institutional trust and self-rated health. Multivariate analyses of self-rated health were performed in order to investigate the importance of possible confounders (age, country of origin, education, economic stress, generalized trust in other people, and care-seeking behaviour) on this association. A 28.7% proportion of the men and 33.2% of the women reported poor self-rated health. A total of 15.0% and 58.3% of the respondents reported "very high" and "rather high" trust in the health-care system, respectively. Almost one-third of all respondents reported low institutional trust. Respondents born outside Sweden, with low/medium education, low generalized trust and low institutional trust had significantly higher odds ratios of poor self-rated health. Multiple adjustments for age, country of origin, education, economic stress, and horizontal trust had some effect on the significant relationship between institutional trust and poor self-rated health, for both men and women, but the additional introduction of care-seeking behaviour in the model substantially reduced the odds ratios. In conclusion, low trust in the health-care system is associated with poor self-rated health. This association may be partly mediated by "not seeking health care when needed". However, this is a cross-sectional exploratory study and the causality may go in both directions.

Aims: This paper explores the relationship between income and health among adults in Sweden. An analysis was made as to what extent the association differs when one studies individual earnings and equivalent disposable income, as well as gender differentials. Further, a study was undertaken to investigate how, and by what magnitude, the income-health relationship changes when one controls for other structural factors, such as education and class. Finally the functional form of the relationship was scrutinized, because of its obvious policy impact., Methods: Data came from the 1996-97 Swedish Living Condition Surveys, which include individuals aged 25-64 (n=7,201). Logistic regression was used, including various polynomial terms of the income variable., Results: The results show that both earnings and disposable household income are strongly related to health, a finding that holds for both women and men. The strength of the association becomes somewhat weaker when one controls for other structural factors, but in the final model the association is in fact about the same as the bivariate association, owing to the impact of age. Moreover, a curvilinear association was revealed by the authors' analyses., Conclusions: A clear association was found between income and health, also when other structural variables are controlled for. This indicates that income, as such, is of great importance for the risk of illness. The shape of the association between income and health is consistent with earlier debates concerning the relation between income distribution and population health indicators, and, as such, indicates that income-equalizing policies may have an impact on health.

Background: It is well known that Swedish-speaking adults in Finland have higher life expectancy and better health than their Finnish-speaking counterparts. Among young people, similar comparisons have been scarce. The present paper aims to compare the health of Swedish-speaking and Finnish-speaking schoolchildren., Methods: Survey data from 1997, representing children at grades 8 and 9 of compulsory school in a bilingual region, are analysed with the help of logistic regression models. Self-rated health as well as objective measures of health are explored., Results: We find that Swedish-speaking schoolchildren are healthier than Finnish-speaking ones in terms of objective measures of health, whereas there is no difference between language groups in terms of self-assessed health. Self-rated health seems to reflect well-being in a very broad context rather than objective health from a medical perspective. Risk factors and health behaviours being equal, both language groups consequently assess their health in a similar manner., Conclusions: Policy makers should be careful when advocating the health needs of schoolchildren based on survey results concerned with self-assessed health measures, particularly when they are concerned with targeting measures towards specific subgroups of the population. Self-rated health is obviously not well suited for reflecting overall and specific needs of medical assistance and expertise for schoolchildren.

Background: The Quality of Life Scale (QOLS), developed originally by John Flanagan in the 1970's, has been adapted for use in chronic illness groups. Evidence for reliability and validity has been published over the years for both English and translations. This paper presents further evidence of construct validity for persons with chronic conditions as well as across two languages, and gender., Methods: A sample of 1241 chronically ill and healthy adults from American and Swedish databases was used to generate factor analyses for both the 15-item original QOLS and the 16-item chronic illness adaptation., Results: Analysis of the data suggested that the QOLS has three factors in the healthy sample and across chronic conditions, two languages and gender. Factors that could be labeled (1) Relationships and Material Well-Being, (2) Health and Functioning, and (3) Personal, Social and Community Commitment were identified., Conclusions: The QOLS is a valid instrument for measuring domains of quality of life across diverse patient groups.

This paper develops a theoretical model of the family as producer of health- and social capital. There are both direct and indirect returns on the production and accumulation of health- and social capital. Direct returns (the consumption motives) result since health and social capital both enhance individual welfare per se. Indirect returns (the investment motives) result since health capital increases the amount of productive time, and social capital improves the efficiency of the production technology used for producing health capital. The main prediction of the theoretical model is that the amount of social capital is positively related to the level of health; individuals with high levels of social capital are healthier than individuals with lower levels of social capital, ceteris paribus. An empirical model is estimated, using a set of individual panel data from three different time periods in Sweden. We find that social capital is positively related to the level of health capital, which supports the theoretical model. Further, we find that the level of social capital (1) declines with age, (2) is lower for those married or cohabiting, and (3) is lower for men than for women.

Unlabelled: This research investigated the situation of 143 unemployed sick leavers at the start of vocational rehabilitation in Sweden. It is argued in this paper that in order to gain a meaningful picture of the vocational rehabilitation process it is necessary to know and understand something of individual differences and status at the onset. In doing so, assessment was carried out of the possible influence of one contextual factor and five individual factors on health, duration of sick leave and unemployment. Findings suggest that individual differences exist in health status, length of sick leave and unemployment, at the upstart of vocational rehabilitating. Locus of control was found to exert important influence on the differences between the individuals in the study sample, with persons of external locus of control having a less favourable point of departure at the start of vocational rehabilitation compared to other groups. It is therefore assumed that these persons will be in greater need of support during the vocational rehabilitation process. The level of unemployment within a geographical area was also found to influence the length of sick leave., Conclusions: Our suggestion is for rehabilitation programs to be developed and selected to match the special needs and differences whether they are of individual or of social nature.

Pliskin, Shepard, and Weinstein identified three preference conditions that ensure that quality-adjusted life years (QALYs) represent preferences over gambles over chronic health profiles. This paper presents an experimental test of the descriptive validity of two of these preference assumptions: utility independence and constant proportional tradeoff. Eighty students at the Stockholm School of Economics and 92 students at Erasmus University Rotterdam participated in the experiment. The results of the experiment support the descriptive validity of constant proportional tradeoff: both within groups and between groups constant proportional tradeoff could not be rejected. The results are less supportive of the descriptive validity of utility independence. Within-groups utility independence was rejected. Between-groups utility independence could not be rejected, but this may have been due to a lack of statistical power. Analysis of the individual responses revealed that without adjustment for imprecision of preference, 39 respondents (22.8%) satisfied constant proportional tradeoff. Twenty-three respondents (13.4%) satisfied utility independence without adjustment for imprecision of preference. However, because of the relative unfamiliarity of the respondents with both the health states to be evaluated and the methods of health-state-utility measurement, it is likely that the respondents' preferences were imprecise. Adjusted for imprecision of preference, the upper estimates of the proportions of respondents who satisfied constant proportional tradeoff and utility independence, respectively, were 90.1% (155 respondents) and 75.6% (130 respondents). Pliskin et al. further derived that if an individual's preferences satisfy both constant proportional tradeoff and utility independence, then these preferences can be represented by a more general, risk-adjusted QALY model. Without adjustment for imprecision of preference, ten respondents (5.8%) satisfied both constant proportional tradeoff and utility independence. Adjusted for imprecision of preference, the upper estimate of the proportion of respondents who satisfied both constant proportional tradeoff and utility independence was 68.6% (118 respondents). The results of this study indicate that constant proportional tradeoff holds approximately. The evidence is much weaker for utility independence, however. This has important implications for the use of QALY-type measures in medical decision making.

This paper analyses the factors involved in differences in the experience of long-term illness (severe and non-severe illness), as measured in terms of self-reported frequency and intensity of symptoms. The study has a cross-sectional design. It uses a database from the Survey of Living Conditions of Statistics Sweden, and treats a representative sample of the employed Swedish population (n = 13,501), aged between 16 and 65, interviewed over the period 1986-89. The results show that male manual workers report more non-severe and severe illness than non-manual workers, and that manual and lower-level non-manual female workers report more severe illness, but not non-severe illness, than intermediate/higher-level non-manual working females. The observed class differences in experience of severity of illness are partly explained by the factors investigated (job demands, personal economic difficulties, smoking daily, weak social network) in the case of men, and virtually entirely in the case of women. Other ill-health dimensions, such as self-rated general health and impaired working capacity, prove to be related to severity of illness, the latter being more strongly associated with experience of severe illness than the former irrespective of social class. The results lend support to the hypothesis that manual classes are subjected to what might be called "double suffering"; they have more long-term illnesses and also experience these illnesses with greater intensity and frequency.

The concept of social welfare functions has been discussed in health economic literature, as it provides a way of examining the extent to which society is prepared to accept a trade-off between efficiency and equity. In this paper requirements for meaningful empirical estimates of the willingness to accept lower per capita health status in order to achieve greater equity are examined. Results from a pilot study aimed at testing the proposed measurement procedure are reported. They show that at least two thirds of the politicians who participated are prepared to accept a lower growth in per capita health in exchange for increased equity. Accordingly, we found a weak empirical support for the common health economic assumption that only total health benefit should guide the use of resources.

The paper presents reference values of the questionnaires Sense of Coherence scale (SOC), measuring self-rated prerequisite for coping ability, and Sickness Impact Profile (SIP), measuring self-rated functional status. The sample used is randomly selected from a Swedish urban population consisting of 145 individuals (75 women, 70 men), divided into three age groups, 26-40, 41-55 and 56-70 years. The mean SOC score was 151 (SD 18) and was not related to gender or age. The total SIP score was low (median 0) as expected in a general population. However, again as expected, the results revealed the functional status being worse in the older group of individuals than in the younger ones. The results might give further validity to the test. The SOC scores were significantly correlated to the overall SIP scores and to the subscales of mental and social character and not to those of a physical nature. Thus, the weaker the SOC the worse the functional status. These findings are suggested to give the Sense of Coherence scale a discriminating validity. A single item concerning general health was also rated by the individuals showing the better the general health the stronger the SOC and the less the dysfunction.

The present paper discusses the following problem; what is the best theoretical understanding of the social class distribution of health and mortality? The discussion identifies some theoretical problems. Some of these have to do with the importance of social causation of health on the one hand and health-related social mobility on the other. Each one of these two explanations has its own problems, but they are not mutually exclusive. The class distribution of early death can vary both between countries, between two periods in time and between causes of death. Such variability should be exploited for theoretical reasons. Empirical 'anomalies' should not be dismissed or ignored, but taken seriously. It seems clear that a theoretical over-simplification in analysing class and health will prove to be counter-productive.

Sheltered housing is a housing model that provides accessible apartments with elevated social possibilities for older people, which is expected to increase resident health and independence, reducing the need for care. As previous research on sheltered housing is scarce, the aim of this study was to explore the characteristics, health status and social participation of older people living in sheltered housing, compared to ageing in place. The study utilised baseline data from a matched cohort study survey on a nationally representative total population of residents in all sheltered housings in Sweden, and a matched control group (n = 3,805). The data collection took place between October 2016 and January 2017. The survey assessed functional capability using the Katz ADL and Lawton IADL scale, self‐rated health using the EQ5D scale, and depressive mood using the GDS‐4 scale. Descriptive statistics, frequencies, mean scores, independent t tests, p‐values and effect sizes were utilised to compare the two groups. The results of the study show that older people living in sheltered housing, compared to ageing in place, had lower self‐reported health (M = 64.68/70.08, p = <0.001), lower self‐reported quality of life (M = 0.73/0.81, p = <0.001), lower functional status concerning activities of daily living (M = 5.19/5.40, p = <0.001), lower functional status concerning instrumental activities of daily living (M = 4.98/5.42 p = <0.001,), and higher probability of depressive mood (M = 0.80/0.58, p = <0.001). The results imply that residents in sheltered housing may have more care needs than those ageing in place. Further longitudinal comparative studies are needed to explore the impact residence in sheltered housing has on resident health and well‐being. [ABSTRACT FROM AUTHOR]

BACKGROUND: Work-related violence is one of the most serious threats to employee safety and health. OBJECTIVE: To ascertain the extent of self-reported violence or threats of violence at work in relation to the general health of public sector employees. METHODS: The study population comprised 9,611 female (83%) and male public employees in Sweden. A questionnaire based on items derived mainly from validated instruments was constructed to cover aspects such as health, lifestyle, and physical and psychosocial work conditions. RESULTS: One in three employees reported work-related violence, with the highest proportions among psychiatric nurses (79%) and psychiatric attendants (75%). Work-related violence more often affected those who were < 45 years old, worked < 40 hours/week, worked nights, or reported poor health. Regardless of gender, age, hours of work, night work, and type of occupation, exposure to work-related violence was associated with less than good general health, and this relationship was strongest for psychiatric nurses (OR=3.19; 95% CI=1.28-7.98), medical doctors/dentists (OR=2.46; 95% CI=1.35-4.49), compulsory school teachers (OR=2.14; 95% CI=1.33-3.45), and other nurses (OR=1.87; 95% CI=1.23-2.84). CONCLUSIONS: Work-related violence was frequently reported by employees in the most common public sector occupations, and it was associated with poor health in both genders. [ABSTRACT FROM AUTHOR]

The primary aim of this prospective study was to investigate whether working despite illness, so called “sickness presenteeism”, has an impact on the future general health of two different working populations during a follow-up period of 3 years. The study was based on two bodies of data collected at a number of Swedish workplaces from 1999 to 2003. The first material comprised 6,901 employees from the public sector and the second 2,862 subjects from the private sector. A comprehensive survey was issued three times: at baseline, after 18 months and after 3 years. Apart from the explanatory variable sickness presenteeism, several potential confounders were considered. The outcome variable was good/excellent versus fair/poor self-reported health. Sickness presenteeism at baseline was consistently found to heighten the risk of fair/poor health at both the 18-month and 3-year follow ups even after adjusting for the detected confounders. To the best of the authors’ knowledge, this study is the first to show that sickness presenteeism appears to be an independent risk factor for future fair/poor general health. [ABSTRACT FROM AUTHOR]

Many post-menopausal women suffer from oestrogen deficiency. This can cause urogenital atrophy which leads to symptoms such as dyspareunia, dysuria, vaginal dryness and urge incontinence. Even though urogenital atrophy is a common condition, little attempt has been made to investigate the impact that the condition has on the quality of life of the women concerned. A quality of life instrument specifically for use with women with urogenital atrophy was developed. The needs-based approach to quality of life was adopted, which states that quality of life is the extent to which an individual is able to satisfy her needs. The development work was undertaken simultaneously in the UK and Sweden. The measure was found to be acceptable and relevant to women in both countries and to have good levels of test-retest reliability (0.92 in the UK and 0.85 in Sweden), internal consistency (alpha coefficients 0.90 in both countries) and construct validity. It is suitable for use in clinical trials and for monitoring the progress of patients in clinical practice. [ABSTRACT FROM AUTHOR]